Introduction: Positional plagiocephaly is nowadays the most frequent consultation at pediatric neurosurgical departments in Spain and western countries. Another important issue is the confusion existing in literature regarding terminology, physiopathology, differential diagnosis with true synostosis and, of course, proper recommendations for treatment.
Objectives: To clarify all these concepts and present a protocol that was recently asked by the Health Administration of the Community of Madrid.
Protocol: Pretends to achieve coordination among paediatricians and neurosurgeons, as much as to offer precise information about data concerning this entity for parents, paediatricians and neurosurgeons.
Material and methods: Previous consensus is reached about some data. Children are classified in three categories of deformation (mild; moderate; severe), according to measurements on digital photography. Diagnosis and treatment follows two phases: Paediatric phase (up to 5 months of age) and Neurosurgical phase (from 5 months on). Children would be referred to neurosurgical consultation only after being treated with postural changes and physiotherapy by the age of 5 months. Reasons are explained in the protocol that defines also functions and responsibilities for each speciality.
Conclusion: Treatment proposed here is staged, starting with postural changes and physiotherapy, followed by orthotic cranial devices and finally surgical treatment.