Evaluation of positional cranial deformities: the non-expert perspective.

The relevance of positional cranial deformity remains a controversial topic. While many specialists support therapeutic intervention with a helmet for severe cases, some are convinced that fears are exaggerated and helmets are unnecessary. In this study, 395 unaffected laypeople were interviewed for their opinion. Standardized photographs of 10 children with different degrees of positional deformity were presented in a randomized order. Values from the literature served as the normal reference (cranial index: 85%; cranial vault asymmetry index: 3.5%). Deformity was regarded as obviously abnormal when at least 50% of the respondents perceived the head as conspicuous. The cut-off value for a therapeutic recommendation was set at 25%. All heads above the reference values were perceived as significantly abnormal by most laypeople, independent of the severity of the deformity. Laypeople saw a need to treat all abnormal infant heads (plagiocephaly: 51.1-72.9%; brachycephaly: 59.5-62.0%; combination: 37.2%). The study results confirmed the existing reference values. Since very mild deformities were perceived as conspicuous and worth treating by the laypeople, the problem is clinically relevant and should not be underestimated. Treatment should therefore be offered regularly. Depending on the severity of the deformity, treatment options may range from conservative therapy (physiotherapy, positioning) to head orthoses in more severe cases.