Since the initiation of the Back to Sleep campaign in 1992, the incidence of positional head shape deformities has increased significantly. While the policy has lowered the rate of sudden infant death syndrome by an estimated 40%, the recommendation for supine sleeping has increased the incidence of occipital cranial flattening by as much as 600% (

Argenta
LC
, et al
J Craniofac Surg
.
1996
;
7
:
5
-11
).

The recommendation for supine sleeping has resulted in a significantly increased incidence of occipital cranial flattening. Numerous risk factors have been implicated; treatment depends to a large extent on the age at presentation.

Strikingly, in Alberta, Canada, a recent prospective study identified 46.6% of infants at 2-month well-child checkups as having at least a mild form of positional cranial deformation by clinically defined criteria (
Mawji
A
 et al
Pediatrics
.
2013
;
132
:
298
-304
)....

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