## 4 Discussion
### Positional Plagiocephaly and Mattress  
The current management of PP involves the use of an orthotic mattress. This could improve the redistribution of pressure on a surface where the infant's skull could normally grow, guided by the brain's expansion. From the early 1990s, the incidence of PP rapidly increased with the \"back to sleep\" campaign, which promoted the supine position to reduce the risk of sudden infant death [29]. To prevent plagioclase, the AAP counsels that newborns should avoid the prone position to sleep, sleep on the back, and stay at a minimum of 30 min in tummy time [70]. An important point to enhance is that the risk of SIDS is 18-fold greater in newborns that sporadically sleep in a prone position [70]. Compared to other protocols based on repositioning advice or helmet orthotics, a sleep curve mattress does not require the child's compliance and is less expensive [71; 72]. A study by [PERSON] et al. describes the changes in head shape using a passive orthotic mattress to treat a group of thirty infants with PP (Table 4) [73]. The mattress is like a passive orthotic device, creating a concavity where the head of the infant can fit. It is intended to reduce the effect of repetitive sleeping position that creates a flat surface. The use of an orthotic mattress in the management of PP showed a reasonable improvement in head form compared to other treatment protocols. Most patients with a severe grade of asymmetry showed minimal deformity at the end of the research [73]. Mobility is one of the most significant accomplishments of infancy, since it allows the infant to become independent and gradually explore new environments and objects. Rolling over from supine to prone is one type of mobility that develops in a child [74]. When a baby turns from supine to prone at the age of six months, this change in body posture is required, and it also marks the beginning of sitting without support [75]. Tummy time is a crucial kind of physical activity for non-mobile infants, according to national and international guidelines [76; 77; 78]. As infants grow, tummy time can also help them become more stable in weight-bearing positions such as sitting and lying prone on their hands and knees [79]. Infants should be placed for sleep in the supine position (entirely on the back) by every caregiver until they are one year old to lower the risk of SIDS. Side sleeping is not recommended or safe [31; 70]. A supine position does not increase choking and aspiration risks. Only infants with specific upper airway abnormalities, such as laryngeal clefts, should be considered to be placed in the prone position while they sleep, since the danger of dying from gastric reflux illness may be greater than the risk of SIDS in these infants [31; 80]. A semi-rigid mattress could be essential for ensuring correct rest and respiration [81; 82; 83]. \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Ref** & **Authors** & **Type of the** & **Aim of the Study** & **Materials** & **Results** \\ \hline \multirow{8}{*}{[73]} & & & 30 patients with a & \\  & & & mean age of five & The improvement of \\  & & & months were included. & cranial symmetry was \\  & & & The grade of & statistically relevant \\  & & & comparison of & asymmetry was & (\(p\) value of 0.001). The \\  & & & cranial deformity of & assessed with CVA & average asymmetry \\
[73] & & Clinical study & & and was classified into & was 5 mm, compared \\  & & & the adoption of a & three ranges: clinically & to the 16 mm at the \\  & & Sleepcurve mattress. & insignificant (CVA & start. The symmetry \\  & & & 6 mm), moderate (CVA & enhancement was \\  & & & 6–12 mm), and high & 11 mm. \\  & & & (CVA \(>\) 12 mm). & \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Sleep curve mattress for the management of PP. The prevalence of SIDS has decreased where supine sleeping has been promoted, although the cause is unknown. One potential cause is the obstruction of the upper airways during sleep.