1
|
Williams E, Galea M. Another look at “tummy time” for primary plagiocephaly prevention and motor development. Infant Behav Dev 2023; 71:101839. [PMID: 37030250 DOI: 10.1016/j.infbeh.2023.101839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/27/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
It is three decades since it was recommended that infants sleep on the back to reduce risk of sudden unexpected infant death (SUID). The SUID prevention program is known as "back to sleep" or "safe sleeping", and this initiative is not questioned. Sleeping on the back is associated with, but not the cause of, the development of infant positional plagiocephaly, also known as deformational or a non-synostotic misshapen head when the skull sutures are open, not fused. This paper provides a synthesis of the history and impact of positional plagiocephaly. It includes a scoping review of plagiocephaly prevention facilitating motor development and reveals few articles on primary prevention which aims to prevent it developing in the first place. It is concerning that preschool-aged children with a history of infant plagiocephaly continued to receive lower developmental scores, particularly in motor development, than unaffected controls, and this may be a marker of developmental delay. Tummy-time (prone) for play is the mainstay of plagiocephaly prevention advice to minimize development of plagiocephaly and to facilitate infant motor development, particularly head control. While tummy-time has shown benefit for infant development, there is limited evidence of its effectiveness in preventing plagiocephaly and some evidence that it promotes only prone-specific motor skills. Most of the published literature is concerned with treatment post-diagnosis, in the form of reviews, or clinical notes. There is a plethora of opinion articles reinforcing tummy-time from birth for plagiocephaly prevention. The review shows that there are gaps in advice for early infant development of head control. An accepted test of head control in infants is "pull to sit" from supine which demonstrates antigravity strength of the neck flexors and coordination of the head and neck when the infant is drawn to sit from supine. This motor skill was cited as achievable by 4 months in the earliest paper on plagiocephaly in 1996. Physical therapists and others should revisit the mechanism of early infant head control development against gravity, particularly antigravity head, neck and trunk coordinated flexion movement in supine, as there has been little attention to early facilitation of this motor skill as a plagiocephaly prevention strategy. This may be achieved by considering "face time" as well as tummy time for primary prevention of plagiocephaly.
Collapse
Affiliation(s)
- Elizabeth Williams
- The University of Melbourne, Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, VIC 3010, Australia.
| | - Mary Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne.Academic Director, Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, VIC 3010, Australia
| |
Collapse
|
2
|
Trottier N, Hurtubise K, Camden C, Cloutier W, Gaboury I. Barriers and facilitators influencing parental adherence to prevention strategies for deformational plagiocephaly: Results from a scoping review. Child Care Health Dev 2023. [PMID: 36609793 DOI: 10.1111/cch.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/06/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Deformational plagiocephaly can be prevented in many healthy infants if strategies are implemented early after birth. However, despite efforts to disseminate accurate information, parental adherence to evidence-based prevention strategies is a challenge. To date, factors - barriers and facilitators - influencing parental adherence to strategies have yet to be identified in a comprehensive manner. OBJECTIVES This scoping review aims to identify and synthesize current evidence on barriers and facilitators impacting adherence of parents of newborns to deformational plagiocephaly prevention strategies. METHODS This review followed the Joanna Briggs Institute (JBI) process guidelines. Seven electronic (Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, SPORTDiscus, Academic Search Complete, AMED, PsychINFO and Scopus) and two grey literature (Health Systems Evidence and Grey Literature Report) databases were searched. Studies published between 2001 and 2022 were included. The deductive thematic data analysis used was guided by the Capability, Opportunity, Motivation Behavioral Model (COM-B) of health behaviour change. RESULTS From a total of 1172 articles, 15 met the eligibility criteria. All components of the COM-B framework were identified. Capability-psychological and opportunity-environmental factors dominated the literature, whereas capability-physical, motivation and, in particular, opportunity-social factors were understudied. The most often reported barriers were a lack of knowledge of deformational plagiocephaly and the associated prevention strategies, ambiguous or inconsistent messaging, intolerance of babies to prone positioning and a lack of time. The most frequently reported facilitators were an awareness of deformational plagiocephaly, postural asymmetry and prevention strategies, skill acquisition with practice, accurate convincing information, scheduled time and environmental organization to position the baby at home. DISCUSSION Recommendations focused on diffusing accurate and detailed information for parents. Our review also suggests a gap regarding the comprehensive identification of factors influencing parental adherence to deformational plagiocephaly prevention strategies. Further studies exploring comprehensive opportunity-social and motivation factors influencing parental adherence to deformational plagiocephaly prevention strategies are warranted to inform prevention programmes and foster better infant outcomes.
Collapse
Affiliation(s)
- Nathalie Trottier
- Faculté de médecine et sciences de la santé, Université de Sherbrooke, Québec, Canada
| | - Karen Hurtubise
- Faculté de médecine et sciences de la santé, Université de Sherbrooke, Québec, Canada
| | - Chantal Camden
- Faculté de médecine et sciences de la santé, Université de Sherbrooke, Québec, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Windy Cloutier
- Faculté de médecine et sciences de la santé, Université de Sherbrooke, Québec, Canada
| | - Isabelle Gaboury
- Faculté de médecine et sciences de la santé, Université de Sherbrooke, Québec, Canada
| |
Collapse
|
3
|
Mothers' Decision Making Concerning Safe Sleep for Preterm Infants: What Are the Influencing Factors? Adv Neonatal Care 2022; 22:444-455. [PMID: 34967776 DOI: 10.1097/anc.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Parental decisions regarding infant sleep practices vary widely, resulting in a lack of adherence to the American Academy of Pediatrics safe sleep recommendations (SSR) and consequently an increased risk of sudden infant death syndrome (SIDS). Preterm infants are among those at a highest risk for SIDS, yet few studies focus on parental decision-making surrounding sleep practices for preterm infants. PURPOSE The purpose of this study was to identify factors influencing decisions concerning infant sleep practices of mothers of preterm infants. METHODS This study used a mixed-methods design. Recruitment was through social media messaging by 2 parent support organizations. An online survey was used to assess factors influencing mothers' decisions regarding sleep practices for preterm infants. FINDINGS/RESULTS Survey participants (n = 98) were from across the United States. Mothers of preterm infants (mean gestational age at birth = 29.42 weeks) most often reported positioning infants on their back to sleep (92.3%) and a low (15.4%) use of a pacifier at sleep time. Three themes emerged for the decisions made: adherence to SSR; nonadherence to SSR; and infant-guided decisions. Regardless of the decision, mothers indicated that anxiety over the infant's well-being resulted in a need for sleep practices that facilitated close monitoring of the infant. IMPLICATIONS FOR PRACTICE AND RESEARCH The findings of this study indicate the need for understanding the underlying anxiety preventing mothers from adhering to SSR despite knowing them, along with tailoring infant sleep messaging and education to improve safety of sleep practices for preterm infants. Research is needed to examine decision making in more diverse populations.
Collapse
|
4
|
Infant Care Practices, Caregiver Awareness of Safe Sleep Advice and Barriers to Implementation: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137712. [PMID: 35805369 PMCID: PMC9265757 DOI: 10.3390/ijerph19137712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
Modifiable infant sleep and care practices are recognised as the most important factors parents and health practitioners can influence to reduce the risk of sleep-related infant mortality. Understanding caregiver awareness of, and perceptions relating to, public health messages and identifying trends in contemporary infant care practices are essential to appropriately inform and refine future infant safe sleep advice. This scoping review sought to examine the extent and nature of empirical literature concerning infant caregiver engagement with, and implementation of, safe sleep risk-reduction advice relating to Sudden Unexpected Deaths in Infancy (SUDI). Databases including PubMed, CINAHL, Scopus, Medline, EMBASE and Ovid were searched for relevant peer reviewed publications with publication dates set between January 2000–May 2021. A total of 137 articles met eligibility criteria. Review results map current infant sleeping and care practices that families adopt, primary infant caregivers’ awareness of safe infant sleep advice and the challenges that families encounter implementing safe sleep recommendations when caring for their infant. Findings demonstrate a need for ongoing monitoring of infant sleep practices and family engagement with safe sleep advice so that potential disparities and population groups at greater risk can be identified, with focused support strategies applied.
Collapse
|
5
|
Sacher R, Wuttke M, Göhmann U, Kayser C, Knabe-Ulner K, Ammermann E, Ammermann M, Krocker B, Fünfgeld L, Spittank H, Derlien S, Loudovici-Krug D. Effects of Single Manual Medicine Treatment for Infants with Postural
and Movement Asymmetries and Positional Preference: A Multicentre Randomised
Controlled Trial – SMMT for IPMA. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2022. [DOI: 10.1055/a-1704-3494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Objective The aim of the study was the evaluation of the effects of a
single manual medicine treatment (SMMT) for infants with postural and motor
asymmetries in upper cervical asymmetry disorder respectively kinematic
imbalance due to suboccipital strain (KISS).
Methods Design: Multicentre double-blind randomised study
Subjects/Setting: 202 infants at the age of 14–24 weeks with
postural and movement findings were examined in four study centres using the
standardized 4-item Symmetry-Score (points: 4=symmetric to
17=asymmetric). The inclusion criterion was a score of at least 10
points. The intervention group (IG) received a SMMT, whereas the control group
(CG) did not receive any manual therapy. In addition, the infants of both groups
were trained with a home exercise programme by their parents.
Statistical Methods The primary target parameter was the result of the
Symmetry-Score, measured before the intervention and 4–6 weeks
afterwards.
Results 171 children were randomised
(IG=83/CG=88). All infants enrolled were measured to the
second time-point (Intention-to-treat-analysis). The average improvement of IG
compared to CG in Symmetry-Score was 2.3 points (p<.001). Following the
score definition 80% of IG and 49% of CG fell below the
treatment threshold of 10 points. No side effects were observed.
Conclusions The SMMT significantly improves postural and motor asymmetries
in infants with KISS.
Collapse
Affiliation(s)
- Robby Sacher
- Gemeinschaftspraxis Freistuhl 3, Praxis für Manuelle Medizin,
Dortmund, Germany
| | - Marc Wuttke
- Gemeinschaftspraxis Freistuhl 3, Praxis für Manuelle Medizin,
Dortmund, Germany
| | - Ulrich Göhmann
- Praxis, Kinderorthopädie – Manualmedizin, Hannover,
Germany
| | | | | | | | | | | | - Liv Fünfgeld
- Praxis, Praxis für Allgmein- und Manualmedizin, Cottbus,
Germany
| | - Holger Spittank
- Praxis, Praxis für Manuelle Medizin & funktionelle
Orthopädie, Münster, Germany
| | - Steffen Derlien
- Institut für Physiotherapie, Universitätsklinikum Jena,
Jena, Germany
| | - Dana Loudovici-Krug
- Institut für Physiotherapie, Universitätsklinikum Jena,
Jena, Germany
- ÄMM, Forschungsberatungssstelle Manuelle Medizin, Jena,
Germany
| |
Collapse
|
6
|
Sacher R, Knüdeler M, Wuttke M, Wüstkamp N, Derlien S, Loudovici-Krug D. Manual therapy of infants with postural and movement asymmetries and positional preference. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-020-00760-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
Background
There are different therapeutic approaches to persistent positional preference (kinematic imbalance due to suboccipital strain, KISS) in infants. There are no evidence-based or controlled studies investigating the effect of manual medicine treatment in children aged 3–6 months, particularly in combination with a home exercise programme. The presented monocentric study on one-time manual medicine treatment of infants aged 14–24 exhibiting these symptoms aims to close this gap.
Methods
This study comprises a controlled double-blind trial and per-protocol-analysis. Primary outcome was the 4-item symmetry score (4–17 points). The second measurement was performed after 4–6 weeks.
Results
A total of 62 infants were treated and evaluated (mean age 17 weeks). The intervention and control groups started with a symmetry score of 12.9 ± 2.1 and 12.5 ± 1.7 points, respectively. In the intervention group the score improved by 4.9 ± 2.4 to 8.0 ± 2.7 points, in the control group it improved by 2.9 ± 2.9 to 9.6 ± 3.0 points. The difference between the groups was statistically significant (p = 0.03). Both groups had significantly better values over time (p < 0.001). No adverse events or side effects were observed.
Conclusion
Manual medicine treatment of infants with postural and movement asymmetries as well as positional preference in combination with a home exercise programme is superior to a home exercise programme alone. Both treatment concepts achieved significant improvements. However, the manual medicine treatment played an important role in reducing the symmetry score value for the affected children, such they were no longer in need of treatment.
Collapse
|
7
|
Nonsynostotic Plagiocephaly: Prevention Strategies in Child Health Care. J Clin Med 2020; 9:jcm9123946. [PMID: 33291382 PMCID: PMC7762044 DOI: 10.3390/jcm9123946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022] Open
Abstract
The dissertation, comprising a clinical intervention and three supporting studies, aimed to assess if it is possible to prevent nonsynostotic plagiocephaly while promoting safe infant sleeping practices. Five individuals were trained to assess cranial asymmetry and then reliability-tested; the interpreted results indicate substantial strength of rater-agreement. Intervention participants were allocated to group. Only intervention group nurses participated in the continuing education on plagiocephaly developed for nurses. A survey compared information intervention and control group parents received from nurses; intervention group parents were significantly more aware of recommendations than the controls. Nurse education was evaluated by asking intervention and control group nurses and parents two open-ended questions; the intervention group reported new re-positioning strategies. The effect of the intervention on cranial shape was evaluated by assessing asymmetry at 2, 4, and 12 months (176 intervention group; 92 controls). It was nine times more common that cranial asymmetry at two months reversed by four months when parents were aware of written recommendations from their nurse (OR = 9.09 [0.02; 0.48], p = 0.004) when adjusted for group. An infant’s risk of asymmetry persisting until 12 months was significantly reduced in the intervention group (RR = 0.35 [0.13; 0.94], p = 0.03). Preventing brachycephaly was difficult. Conclusions: the assessors were considered reliable; educating nurses promoted the integration of new recommendations in practice; the intervention was associated with early reversal of nonsynostotic plagiocephaly.
Collapse
|
8
|
Collett BR, Wallace ER, Kartin D, Cunningham ML, Speltz ML. Cognitive Outcomes and Positional Plagiocephaly. Pediatrics 2019; 143:peds.2018-2373. [PMID: 30635350 PMCID: PMC6361360 DOI: 10.1542/peds.2018-2373] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5972296741001PEDS-VA_2018-2373Video Abstract BACKGROUND: Studies have revealed an association between positional plagiocephaly and/or brachycephaly (PPB) and development, although little is known about long-term outcomes. We examined cognition and academic achievement in children with and without PPB, testing the hypothesis that children who had PPB as infants would score lower than controls. METHODS We enrolled 187 school-aged children with a history of PPB and 149 controls. Exposures were the presence or absence and severity of infancy PPB (mild, moderate to severe). Cognitive and academic outcomes were assessed by using the Differential Ability Scales, Second Edition and Wechsler Individual Achievement Test, Third Edition, respectively. RESULTS Children with PPB scored lower than controls on most scales of the Differential Ability Scales, Second Edition (standardized effect sizes [ESs] = -0.38 to -0.20) and the Wechsler Individual Achievement Test, Third Edition (ESs = -0.22 to -0.17). Analyses by PPB severity revealed meaningful differences among children with moderate to severe PPB (ESs = -0.47 to -0.23 for 8 of 9 outcomes), but few differences in children with mild PPB (ESs = -0.28 to 0.14). CONCLUSIONS School-aged children with moderate to severe PPB scored lower than controls on cognitive and academic measures; associations were negligible among children with mild PPB. The findings do not necessarily imply that these associations are causal; rather, PPB may serve as a marker of developmental risk. Our findings suggest a role for assessing PPB severity in clinical practice: providing developmental assessment and intervention for infants with more severe deformation and reassurance and anticipatory guidance for patients with mild deformation.
Collapse
Affiliation(s)
- Brent R. Collett
- Center for Child Health, Behavior, and Development and,Departments of Psychiatry and Behavioral Sciences
| | | | | | - Michael L. Cunningham
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, Washington;,Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and,Seattle Children’s Craniofacial Center, Seattle, Washington
| | - Matthew L. Speltz
- Center for Child Health, Behavior, and Development and,Departments of Psychiatry and Behavioral Sciences
| |
Collapse
|
9
|
Collett BR, Wallace ER, Kartin D, Speltz ML. Infant/toddler motor skills as predictors of cognition and language in children with and without positional skull deformation. Childs Nerv Syst 2019; 35:157-163. [PMID: 30377774 PMCID: PMC6447299 DOI: 10.1007/s00381-018-3986-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To estimate associations between early motor abilities (at two age points, 7 and 18 months on average) and cognitive/language outcomes at age 3. To determine whether these associations are similar for children with and without positional plagiocephaly and/or brachycephaly (PPB). METHODS The Bayley Scales of Infant/Toddler Development 3 were given at all age points to 235 children with PPB and 167 without PPB. Linear regressions assessed longitudinal associations between fine and gross motor scales and cognition/language. Item analyses examined the contributions of specific motor skills. RESULTS Associations between 7-month motor skills and cognition/language were modest overall (effect sizes [ES] = - 0.08 to 0.10, p = .13 to .95). At 18 months, both fine and gross motor skills were associated with outcomes for children with PPB (ES = 0.21 to 0.41, p < .001 to .01), but among those without PPB, only fine motor skills were associated with outcomes (ES = 0.21 to 0.27, p < .001 to .001). CONCLUSIONS Toddlers' motor skills were associated with cognition and language at 3 years, particularly among children with PPB. Interventions targeting early motor development in infants and toddlers with PPB may have downstream benefits for other outcomes.
Collapse
Affiliation(s)
- Brent R. Collett
- Corresponding Author: Brent R. Collett, Ph.D., Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, 2001 8th Ave, CW8-6, Seattle, WA 98102,
| | - Erin R. Wallace
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
| | | | - Matthew L. Speltz
- Psychiatry and Behavioral Sciences, University of Washington, Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
| |
Collapse
|
10
|
Ballardini E, Sisti M, Basaglia N, Benedetto M, Baldan A, Borgna-Pignatti C, Garani G. Prevalence and characteristics of positional plagiocephaly in healthy full-term infants at 8-12 weeks of life. Eur J Pediatr 2018; 177:1547-1554. [PMID: 30030600 DOI: 10.1007/s00431-018-3212-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Positional plagiocephaly (PP) denotes flattening of the skull that occurs frequently in healthy infants. Aim of this study was to estimate the prevalence of positional plagiocephaly and to identify the risk factors in a cohort of healthy infants in order to help prevention of PP. In a prospective design, all healthy full-term infants, ranging from 8 to 12 weeks of age, who presented at the public immunization clinic in Ferrara, were eligible for the study. After obtaining informed consent, we interviewed the parents and examined the infants using the Argenta's assessment tool. Of 283 infants examined, 107 (37.8%) were found to have PP at 8-12 weeks of age. In 64.5%, PP was on the right side, 50.5% were male and 15% presented also with brachycephaly. Risk factors significantly associated were lower head circumference, advanced maternal age, Italian compared to African, and supine sleep position, in particular for infants born at 37 weeks, preference for one side of the head. In logistic regression, risk factors significantly associated were lower birth weight, advanced maternal age, and supine sleep position. CONCLUSIONS Positional plagiocephaly is a common issue faced by pediatricians; our results reinforce the need of improving prevention both of sudden infant death and positional plagiocephaly, through uniform messages provided prenatally and postnatally by different health professionals. "What is Known:" •The incidence of positional plagiocephaly varies due to population studied and measuring methods. •Different factors are considered in the literature as being associated to positional plagiocephaly (infant factors, obstetric factors, infant care practices, sociodemographic factors). "What is New:" •This is one of the few European studies quantifying positional plagiocephaly prevalence in a population of unselected healthy infants. •In this study, positional plagiocephaly is confirmed as a common issue, related to some factor (as supine sleep position and positional head prevalence) that should be addressed in pre and postnatal counseling. •The prone sleepers rate in our population highlight the need to improve parental awareness regarding SIDS prevention, in particular in borderline gestational age.
Collapse
Affiliation(s)
- Elisa Ballardini
- Department of Medical Sciences, Pediatric Section, Neonatal Intensive Care Unit, University of Ferrara, Via Aldo Moro, 8-44124 Cona, Ferrara, Italy.
| | - M Sisti
- Department of Neurosciences and Rehabilitation Medicine, University of Ferrara, Ferrara, Italy
| | - N Basaglia
- Department of Neurosciences and Rehabilitation Medicine, University of Ferrara, Ferrara, Italy
| | - M Benedetto
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy
| | - A Baldan
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy
- Department of Pediatrics, Texas Children's Hematology Center, Baylor College of Medicine, Houston, TX, USA
| | - C Borgna-Pignatti
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy
| | - G Garani
- Department of Medical Sciences, Pediatric Section, Neonatal Intensive Care Unit, University of Ferrara, Via Aldo Moro, 8-44124 Cona, Ferrara, Italy
| |
Collapse
|
11
|
Lennartsson F, Nordin P, Ahlberg BM. Integrating new knowledge into practice: An evaluation study on a continuing education for Swedish child health nurses on non-synostotic plagiocephaly. Nurs Open 2018; 5:329-340. [PMID: 30062027 PMCID: PMC6056432 DOI: 10.1002/nop2.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/15/2018] [Indexed: 11/10/2022] Open
Abstract
AIM The aim of this study was to assess what knowledge on non-synostotic plagiocephaly prevention and reversal intervention and control group nurses imparted to parents and parents integrated in infant care. DESIGN A group of nurses participated in a continuing education on non-synostotic plagiocephaly in one-to-one or small group sessions at their workplace and received guidelines to follow. An evaluation was conducted with 35 intervention group and 15 control group nurses by asking them two open-ended questions 1 year later; 181 intervention group and 90 control group parents were also asked two open-ended questions and to rate their infant's head shape. METHODS Data were collected during the year 2013. Qualitative content analysis and case-by-case analysis were conducted using a process-oriented approach. RESULTS Intervention group nurses imparted both regular and newly introduced knowledge on positioning strategies to parents. Intervention group parents who perceived severe cranial asymmetry when infants were 3-4 months old reported implementing regular and new infant positioning recommendations.
Collapse
Affiliation(s)
- Freda Lennartsson
- Institutionen for kliniska vetenskaperAvdelning för pediatrikGöteborgs universitetGöteborgSweden
| | | | | |
Collapse
|
12
|
Abstract
BACKGROUND More than 95% of higher-order multiples are born preterm and more than 90% are low birth weight, making this group of infants especially vulnerable to sudden infant death syndrome (SIDS). Emerging evidence suggests that families with twins face challenges adhering to the American Academy of Pediatrics (AAP) recommendations to reduce SIDS risks. Adherence to the AAP recommendations in families with higher-order multiples has not been described. PURPOSE This study describes SIDS risk reduction infant care practices for higher-order multiples during the first year of life. METHODS Mothers caring for higher-order multiple-birth infants were recruited from an online support group. An online survey was used to assess infant care practices when the infants were first brought home from the hospital as well as at the time of the survey. RESULTS Ten mothers of triplets and 4 mothers of quadruplets responded. Less than 80% of the mothers practiced "back to sleep" immediately postdischarge. Supine sleep positioning decreased over time, particularly during daytime naps. Only 50% of the infants shared the parents' bedroom and approximately 30% bed-shared with their siblings. Sleep-time pacifier use was low. IMPLICATIONS FOR PRACTICE Safe sleep education must include specific questions regarding home sleeping arrangements, encouragement of breast milk feedings, supine positioning, and pacifier use at every sleep for higher-order multiple infants well before discharge in order for parents to plan a safe sleep environment at home. IMPLICATIONS FOR RESEARCH Prospective studies to identify barriers and facilitators can inform future strategies supporting adherence to safe sleep practices for higher-order multiple infants.
Collapse
|
13
|
Linz C, Kunz F, Böhm H, Schweitzer T. Positional Skull Deformities. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:535-542. [PMID: 28835328 PMCID: PMC5624275 DOI: 10.3238/arztebl.2017.0535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 12/29/2016] [Accepted: 04/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Especially in the first 6 months of life, skull deformities manifesting as a uni- or bilateral flattening of the occiput often give rise to questions of differential diagnosis and potential treatment. In this review, the authors summarize the current understanding of risk factors for this condition, and the current state of the relevant diagnostic assessment and options for treatment. METHODS The recommendations given in this selective review of the literature are based on current studies and on existing guidelines on the prevention of sudden infant death, the recommendations of the German Society for Pediatric Neurology (Deutsche Gesellschaft für Neuropädiatrie), and the American guidelines on the treatment of positional plagiocephaly in infancy. RESULTS Pre-, peri-, and postnatal risk factors can contribute to the development of positional skull deformities. These deformities can be diagnosed and classified on the basis of their clinical features, supplemented in unclear cases by ultrasonography of the cranial sutures. The putative relationship between positional skull deformities and developmental delay is currently debated. The main preventive and therapeutic measure is parent education to foster correct positioning habits (turning of the infant to the less favored side; prone positioning on occasion when awake) and beneficial stimulation of the infant (to promote lying on the less favored side). If the range of motion of the head is limited, physiotherapy is an effective additional measure. In severe or refractory cases, a skull orthosis (splint) may be useful. CONCLUSION The parents of children with positional skull deformities should be comprehensively informed about the necessary preventive and therapeutic measures. Treatment should be initiated early and provided in graded fashion, according to the degree of severity of the problem. Parental concern about the deformity should not be allowed to lead to a rejection of the reasonable recommendation for a supine sleeping position.
Collapse
Affiliation(s)
- Christian Linz
- University Hospital of Würzburg, Center for Craniofacial Surgery, Department of Oral and Maxillofacial Plastic Surgery
| | - Felix Kunz
- University Hospital of Würzburg, Department of Orthodontics
| | - Hartmut Böhm
- University Hospital of Würzburg, Center for Craniofacial Surgery, Department of Oral and Maxillofacial Plastic Surgery
| | - Tilmann Schweitzer
- University Hospital of Würzburg, Department of Neurosurgery, Section of Pediatric Neurosurgery
| |
Collapse
|