Most pediatricians are aware that plagiocephaly (asymmetric head shape), and brachycephaly (wide head shape), occur frequently in young infants, with some estimates placing the incidence as high as 19 to 40%. Plagiocephaly and brachycephaly occurs from there is prolonged pressure on the skull before or after birth and is more easily corrected before ossification begins at 5 to 6 months of age. Congenital muscular torticollis, resulting from shortening of the sternocleidomastoid muscle unilaterally can contribute to the development of these conditions. Plagiocephaly and brachycephaly, if not diagnosed and left untreated place an infant at risk for facial asymmetry, mandibular asymmetry, asymmetric motor skills, and increased risk of development delay. They are also associated with increased risk of in utero positional deformities such as clubfoot and developmental hip dysplasia. 

Treatment of brachycephaly and plagiocephaly with or without congenital muscular torticollis involves range of motion and positional therapy. Often affected children who are diagnosed late or do not improve are then referred for physical therapy.  If diagnosed after 5-6 months of age or when other therapies do not produce adequate improvement, helmet therapy is then indicated.

It is estimated that only a fraction of the babies born each year with plagiocephaly and or brachycephaly are treated, leaving the remainder undiagnosed and never treated. 

SoftSpot Application

Two scientist parents whose child was diagnosed with plagiocephaly, thought there should be a better way to screen for these conditions as well and monitor improvement with therapy.  They joined with other scientists to investigate the possibility of making a mobile application to facilitate the diagnoses and monitor therapy. The company, PediaMetrix was formed in 2018, and now after years of research and development they now have FDA approval to market their prescription based mobile application called SoftSpot. 

Neurosurgery and craniofacial centers employ hand calipers to measure the cranial index. The oblique diagonal difference is a measurement of the asymmetry of the skull. These measurements quantify the severity of the problem and are used to determine if the infant would benefit from positional and range of motion therapy, physical therapy, or helmet therapy.

The SoftSpot application is available on android and ios platforms. A cap is placed on the infant’s head to prevent artifacts due to the baby’s hairline, a sticker placed on the top of the head and a short video taken via the SoftSpot application. This is then upload to the PediaMetrix site where AI based algorithms are used to compute cranial measurements.  A report is sent to the pediatrician who can discuss this with parents and make recommendations. Measurements are taken monthly for those infants who are being observed, or who are receiving therapy, and a progress report sent to the pediatrician. 

The application is easy to use and is expected to be very affordable.  PediaMetrix has recently received an NIH grant to develop a mobile application that may be able to identify infants at risk for craniosynostosis. 

I think the application lends itself to Telehealth visits, and can help identify the many babies with plagiocephaly or brachycephaly that go undiagnosed and untreated.  Stay tuned!