Enhancing Infant Positional Plagiocephaly and Brachycephaly Prevention by Creating Effective Teaching Materials

Infant positional plagiocephaly (PP) and brachycephaly are two of three presentations of nonsynostotic deformational plagiocephaly. These conditions present as flattened areas to the infant's skull. The head shape with PP often resembles a parallelogram, whereas brachycephaly presents as flattening to the back of the head. The incidences of PP and brachycephaly have increased dramatically since the initiation of the American Academy of Pediatrics' (AAP) 1992 Back to Sleep Campaign. The AAP recommends that parents place their infants supine for sleep. Prior to 1992, the incidence of PP and brachycephaly was 1 in 300, whereas a recent study indicates 46.6% of infants, 7 to 12 weeks of age, present with some degree of skull deformity. Adverse conditions associated with PP and brachycephaly include abnormal skull and facial features and psychosocial effects. Infant PP and brachycephaly are preventable after birth. These conditions are easy to manage if detected in early infancy. Measures to educate parents regarding supine sleep are emphasized in the neonatal period. However, efforts to teach PP and brachycephaly prevention are not readily implemented. Barriers to educating parents include vague guidelines, provider time constraints, and legal concerns. The optimal time to teach preventative measures is during the prenatal, neonatal, or early infancy stages. However, the majority of parents do not receive appropriate preventative education at these early stages. The purpose of this project was to create an educational video and pamphlet that clarify preventative guidelines. The objective involved the abridgement of evidence-based and expert opinion data into one guideline, which was reviewed by the project chair and content experts. This guideline served as the foundation for the educational material. Two focus groups were recruited: a parent focus group and an interdisciplinary professional focus group. The parent group addressed the design of the educational materials, whereas the professional group focused on the accuracy of the information. Feedback from the focus groups, utilizing a pre- and post-questionnaire, guided the development of the educational materials. The project chair and content experts reviewed the pre- and post-questionnaires prior to focus group distribution. A videographer assisted with the design and production of an educational video. A graphic artist assisted with the design and construction of a pamphlet that highlights the important aspects of the video. Feedback from the focus groups, project committee, and content experts influenced the final version of the educational materials. This feedback ensured the accuracy of the content and the appropriateness for the targeted audience. These materials were prepared for future distribution to healthcare and web-based health organizations as parental teaching tools. This quality improvement project addressed the current barriers that exist to teaching preventative measures to improve the likelihood that parents receive the information in a timely manner. Providers benefit in that easy access to quality educational materials allow them to forward the information to parents at the optimal stages of infant development. The material can be accessed as a website link or as a hard copy. Parents benefit with an increased awareness of PP and brachycephaly and the knowledge to intervene with preventative measures.