ABOUT PLAGIOCEPHALY |
|
| |
|
Positional Plagiocephaly is a disorder in which the back or one side of an infant's head is flattened, often with little hair growing in that area. It's most often the result of babies spending a lot of time lying on their backs for SIDS prevention (Sudden Infant Death Syndrome) or often being in a position where the head is resting against a flat surface (such as in cribs, strollers, swings and playpens).
Even though the flat head has been considered to be a pure aesthetic problem, a recent case-control study led by Matthew L. Speltz, PhD at the Seattle Children Hospital1; which included 235 infants with deformational plagiocephaly and 237 normal infants found that the infants with flat heads had significantly lower mean scores on neurodevelopmental tests.
Flat Head Syndrome is a familiar phrase that refers to multiple medical conditions; which includes plagiocephaly, brachycephaly, doliocephaly and craniosynostosis.
Typically, the average skull is one third longer than it is wide. Passage through the birth canal often makes a newborn's head appears pointy or elongated for a few days. Because infants' heads are soft to allow for the incredible brain growth that occurs in the first year of life, they're susceptible to being "molded" into a flat shape.
|
| |
 |
 |
A baby's skull is made up of several separate bones. It may be slightly misshapen during the few days or weeks after birth. However if a baby develops a persistent flat spot, either on one side (Plagiocephaly) or the back of the head (Brachycephaly), it may be a sign of positional plagiocephaly also known as flat head syndrome. Head flattening due to other reasons such as Craniosynostosis, which can be a serious medical condition, is not addressed in this web site. If flattening is noted, it is recommended that it be evaluated by your child’s doctor for medical diagnosis. |
|
| |
Over the past several years, pediatricians have seen an increase in the number of children with cranial asymmetry, particularly unilateral flattening of the back of the head (occiput). Today deformational plagiocephaly have today reached epidemic proportions. This increase is likely attributable to parents following the American Academy of Pediatrics "Back-to-Sleep" positioning recommendations aimed at decreasing the risk of SIDS. Since 1992, the incidence of positional plagiocephaly has increased dramatically with a concurrent rise in the incidence of torticollis.
Although associated with some risk of deformational plagiocephaly, healthy young infants should be placed down for sleep on their backs for SIDS prevention. This practice recommended by the American Academy of Pediatrics, has been associated with a more than 40% decrease of incidence of sudden infant death syndrome (SIDS). However, a comparable increase in the posterior deformational plagiocephaly occurred.
|
| |
1 - Plagiocephaly, Brachycephaly, Dolicocephaly and Torticollis (“Wry Neck”) |
| |
Positional or deformational plagiocephaly refers to a flattening of the right or left occiput caused by repeated pressure to one side of the back of the soft enfant skull. Multiple terms have been used to describe this posterior skull deformation: functional synostosis, plagiocephaly without synostosis, deformational plagiocephaly, positional plagiocephaly, lambdoid positional molding, occipital plagiocephaly, and positional skull deformity. |
| |
 |
|
PLAGIOCEPHALY when looked at from above the baby’s head, one ear may look more forward than the other. Plagiocephaly literally means “oblique head” (from the Greek words “plagio” meaning oblique and “cephale” meaning head). When looked at from above the baby’s head, a "parallelogram" skull shape strongly suggests deformational plagiocephaly.
|
|
Deformational plagiocephaly (flat head syndrome) produces an undesirable effect on the aesthetic appearance. Baby flat head syndrome does not only lead to distortion of the skull shape but sometimes also facial asymmetry. |
| |
 |
|
In the severe Plagiocephaly cases:
- one eye appears larger than the other,
- the ear on the flattened side is pushed forward than the other side,
- eyes alignment variations
- one cheek appears fuller than the other
Forehead on the flattened side is more prominent.
|
|
| |
| BRACHYCEPHALY refers to a condition where the head is disproportionately wider compared to its depth. Flattening of the occiput (the back of the head) is due to the constant pressure on the back of the head when staying in supine position (laying back). |
|
 |
|
| |
 |
|
DOLICOCEPHALY is defined as the lateral head flattening in preterm babies. It is a common skull distortion due to the constant pressure on the sides of the head. This results in infants with long and narrow heads. |
|
| |
TORTICOLLIS is caused by the unilateral tightness or shortening (imbalance) of one or more of the cervical muscles (particularly the Sternocleidomastoid muscle). Plagiocephaly is often associated with a torticollis where there is some limit of active neck movements that leads to a preference to turn the head to one side.
Torticollis could be both a cause and effect of deformational plagiocephaly:
- Some infants born with torticollis related to placement in utero during pregnancy or to a birthing cervical trauma, or from other underlying disorders develop plagiocephaly after birth. If the infant is born with congenital muscular torticollis, the turn and tilt of the head from the shortened sternocleidomastoid muscle initiates the side preference and the occiput flattens correspondingly.
- Alternatively, the child could first develop a preference for head positioning with positional plagiocephaly, and the persistence of the head rotated in one direction could cause chronic shortening of the cervical muscles resulting in a torticollis.
|
| |
2 - Most Common Causes of Positional Plagiocephaly: |
| |
 |
|
The supine sleep position has been strongly associated with deformational plagiocephaly. When demographics are compared in studies, the majority of infants with deformational plagiocephaly sleep supine. As the infant spends more time supine or reclining with his or her head on a hard surface, the occiput is more likely to deform. |
|
| |
Infants who require to be placed in Newborn Intensive Care Unit (NICU) as well as premature infants are more prone to positional plagiocephaly since their skull is softer and they spend the majority of their time on their backs.
Positional plagiocephaly can also be developed before birth if the mother’s pelvis or a twin is exerting a strenuous force. Actually, it is common to see plagiocephaly in multiple birth infants. Some congenital malformations such as congenital hip dysplasia, congenital scoliosis or torticollis are associated strongly with deformational plagiocephaly. |
| |
3 - Positional Plagiocephaly Prevention: |
| |
| Healthy babies should be placed on their backs to sleep for naps and at night to reduce the risk of Sudden Infant Death Syndrome (SIDS). Parents should not stop placing babies on their backs to sleep. |
| |
|
Thanks to its design, the Doctor’s developed Lifenest® Sleeping System helps prevent Plagiocephaly:
 The Lifenest® cuddles the baby’s head helping to prevent positional flattening.
The increases of the contact surface reduce the pressure per square inches.
The Lifenest comfortable supportive netting allows the baby’s head to move freely.
During the supervised Tummy Time, the baby may breathe through the netting. |
  |
| |
| Most cases of positional plagiocephaly can be prevented (and sometimes corrected) by repositioning, which relieves pressure from the back of an infant’s head. Techniques for repositioning include: |
| |
- Providing "Tummy Time" when your baby is awake and someone is watching. Tummy Time not only helps prevent flat spots, but it also helps the baby's head, neck, and shoulder muscles get stronger as part of normal development.
- Changing the direction that your baby lies in the crib from one week to the next.
- Changing the location of the baby's crib in the room so that he or she has to look in different directions to see the door or the window.
- Avoiding too much time in car seats, carriers, and bouncers while the infant is awake.
- Getting "cuddle time" with the baby by holding him or her upright over one shoulder often during the day.
|
| |
4 - Positional Plagiocephaly Diagnostic and Treatments: |
| |
Positional plagiocephaly is generally easy for parents to notice. Most often, the diagnosis does not need X-rays or lab tests. A simple examination by a doctor is generally enough to make the diagnosis of positional plagiocephaly.
If the problem is detected early, repositioning (described above) can successfully correct positional plagiocephaly. In most cases, flat spots on the head go away on their own once an infant starts sitting up and crawling.
More severe cases of positional plagiocephaly can usually be treated successfully with a custom helmet or custom band. The success rate for this kind of therapy is high when it's started early (around 6 months). If you're starting late, your baby's skull may not become perfectly symmetrical. Keep in mind that some asymmetry is normal. And as your child's hair grows, it will likely hide some of the remaining flattening.
Talk to your health care provider about your baby’s head shape at each well-baby checkup. |
| |
Sources:
1. M. L. Speltz, PhD, B. R. Collett, PhD, M. Stott-Miller, MS, 2010, Case-Control Study of Neurodevelopment in Deformational Plagiocephaly, Pediatrics, Vol. 125 No. 3 March 1st, 2010, e537-e542
The contents of this page, such as text, graphics, images, and other material are for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. |
| |
| © Ubimed® Copyrights 2012 |
|
|
