Objectives: We compare positioning with orthotic therapy in 298 consecutive infants referred for correction of head asymmetry.Study design: We evaluated 176 infants treated with repositioning, 159 treated with helmets, and 37 treated with initial repositioning followed by helmet therapywhen treatment failed.We compared reductions in diagonal difference (RDD)-between repositioning and cranial orthotic therapy.Helmets were routinely used for infants older than 6 months with DD >1 cm.Results: For infants treated with repositioning at a mean age of 4.8 months, the mean RDD was 0.55 cm (from an initial mean DD of 1.05 cm).For infants treated with cranial orthotics at a mean age of 6.6 months, the mean RDD was 0.71 cm (from an initial mean DD of 1.13 cm).Conclusions: Infants treated with orthotics were older and required a longer length of treatment (4.2 vs 3.5 months).Infants treated with orthosis had a mean final DD closer to the DD in unaffected infants (0.3 ±0.1 cm), orthotic therapy was more effective than repositioning (61%decrease versus 52%decrease in DD), and early orthosis was significantly more effective than later orthosis (65%decrease versus 51%decrease in DD).
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