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An Update Of Cephalic Index Norms In A Large And Diverse Population Of Well Children
Alannah L. Phelan, MD, Jing Xu, BS, Garrick Gu, BA, Jacob Wood, BS, Joyce K. McIntyre, MD, Janice F. Lalikos, MD.
University of Massachusetts Medical School, Worcester, MA, USA.

PURPOSE:
The incidence of brachycephaly has increased since the implementation of Back-to-Sleep Campaign. Current cephalic index (CI) norms, established by a small sample of Caucasian children in the 1980's, need to be updated. This study aims to redefine the CI norm and to examine risk factors related to increased CI.
METHODS:
Children aged 0-6 months, 7-12 months, 2-3 years, and 12-14 years are enrolled. Those with plagiocephaly or other craniofacial disorders are excluded. Biparietal and anteroposterior diameters are obtained using a manual caliper. A survey containing the subjects' birth, past medical and sleeping history is administered.
RESULTS:
1,156 subjects are included. 41% are Caucasian, 31% are Hispanic, 18% are African American and 9% are Asian. Mean CI for 0-6 months are 83.26.55 for males and 83.25.93 for females, which is significantly greater than the established norms of 74.45.2 and 74.36.1, respectively (p<0.0001). Asian race and back sleep are risk factors for increased CI (p<0.0005). Scatterplot of CI and age shows positive trend from 0-6 months (R2=0.051, p<0.0001) and negative trend from 7-48 months (R2=0.021, p=0.0009).
CONCLUSION:
Mean CI has increased for 0-6 months infants compared to the old norms. Asian race and back sleep are associated with increased CI. CI increases before 6 months, and naturally decreases afterwards without intervention. The current criteria for orthotic treatment should be re-examined due to this shift in CI norms.


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