Misshapen Head (Plagiocephaly)
What is Plagiocaphaly?
Plagiocephaly (also referred to as ‘Positional Plagiocephaly’ or ‘Deformational Plagiocephaly’) means ‘misshapen head’. When babies are born, the joins between the skull bones, called ‘fontanelles’, have not yet fused. This makes it easier for the baby to pass through the birth canal during delivery. The fontanelles gradually fuse during the first 18 months of life. Before the fontanelles fuse, the skull is soft and a flat spot can develop if too much time is spent in the one position.
The flat spot usually develops on the back of the head and is often accompanied by a stiff neck, or preference to turn the head in one direction. In more severe cases Plagiocephaly can cause asymmetry in the facial features, for example, one eye may appear higher than another or the ear on one side might sit further forward than the other.
What causes Plagiocephaly?
Plagiocephaly is caused by pressure on the one spot for extended periods of time. This can happen in-utero, for example, when a baby is in breech position or if there is over crowding (e.g., twins). Sometimes Plagiocephaly develops after the baby is born. This can happen when babies spend a lot of time on their backs, for example, in car seats, bouncer seats and prams. It can also develop when babies always sleep with their head turned to the same side. Premature babies are more likely to develop Plagiocephaly because their skull bones are very soft following birth and they have not yet developed the strength to move their head around.
Plagiocephaly has become more common since the recommendation to place babies on their backs to sleep was introduced in the 1990s. For safety, all babies should be placed on their back to sleep, even if they have Plagiocephaly. Donut cushions, and any other positioning devices, are not safe to use. For information about safe sleeping, please refer to SIDS and Kids Safe Sleeping http://www.sidsandkids.org/safe-sleeping/
How is Plagiocephaly treated?
The treatment recommended for Plagiocephaly depends on how severe it is. Plagiocephaly itself does not cause any problems with brain development and treatment to regain a round head shape is for cosmetic reasons. Mild Plagiocephaly will usually resolve by itself, but when the baby also has a preference to turn their head to one side, treatment is important because untreated Torticollis can cause problems with gross motor, vision and vestibular development.
Moderate and severe cases of Plagiocephaly should be treated to prevent permanent changes to the skull shape and facial features. When Plagiocephaly is identified early, it can be treated effectively by positioning the baby to take pressure off the flat spot of the head. This is most effective during the first 4 months of life. In more severe cases, or when Plagiocephaly is identified late, your baby may need to wear a helmet to help remodel the shape of their head. Helmets are custom made by Paediatric Orthotists and are light-weight and comfortable to wear. They are most effective between 4 and 8 months of age because this is when the skull grows the most. The length of time each baby needs to wear the helmet varies, but usually they need to be worn for 2-6 months.
How can I reduce the risk of my baby developing Plagiocephaly?
Always position your baby on their back to sleep. Varying the position of the baby in the nursery can help to encourage your baby to sleep with their head to both sides. For example, change the direction you position your baby in the cot so that sometimes they are prompted to turn their head to the right and sometimes to the left to look out into the room - they will be more inclined to turn their head towards sound and interesting objects rather than towards a blank wall.
When your baby is awake, help them to play in positions that take the pressure off the back of their head. For example, try positioning your baby to play on their tummy or on their side with a rolled up towel along their back to help them maintain the position.
If your baby is able to control their head when held in a sitting position, you can place them on your lap and give them enough support around their trunk to stay steady while they play with their favourite toy. Experiment with different ways to carry your baby so that they are either on their tummy, side or sitting upright. Try to limit the amount of time spent in the car capsule, car seat, pram, bouncer and any other positioning devices where your baby is lying on their back.
If you are concerned that your baby has a flat spot on their head and/or a preference to turn their head to one side, please consult your GP, Paediatrician, Paediatric Physiotherapist or Maternal Child Health Nurse.
Bialocerkowski, A. (2008). Physiotherapy reduces the risk of deformational plagiocephaly in infants who have a preferred head position when lying supine, Australian Journal of Physiotherapy, vol. 54, no. 4, pp 283-283.
Mawji, A., Vollman, A.R., Hatfield, J., McNeil, D., & Sauve, R. (2013). The incidence of positional plagiocephaly: a cohort study. Pediatrics, vol. 132, no. 2, pp 298-304.
Robinson, S & Proctor, M. (2009). Diagnosis and management of deformational plagiocephaly, Journal of Neurosurgery, vol. 3, no. 4, pp 284-295.
Meara, J.G, Padwa, B. (2011). Plagiocephaly in children. Retrieved from Boston Children’s Hospital http://www.childrenshospital.org/conditions-and-treatments/conditions/plagiocephaly
Sids and Kids National Scientific Advisory Group. (2013). Safe Sleeping: Pillow Use. Retreived from http://www.sidsandkids.org/wp-content/uploads/SIDS_SafeSleeping_A4_IS_Section2_PillowUseweb2.pdf.