Passage through the birth canal often makes a
newborn's
head appear pointy or elongated for a short time. It's normal
for a baby's skull, which is made up of several separate bones
that will eventually fuse together, to be slightly misshapen during
the few days or weeks after birth.
But if you've noticed that your baby is developing a
persistent flat spot, either in the back or on one side of the
head, it could be a sign of positional plagiocephaly. Also known as
flattened head syndrome, this can occur when a baby sleeps in the
same position repeatedly or because of problems with the neck
muscles.
Fortunately, positional plagiocephaly usually is easy to treat,
and with appropriate intervention will correct itself by the time a
child is 1 year old.
About Positional 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 or often being in a
position where the head is resting against a flat surface (such as
in cribs, strollers, swings, and playpens).
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.
The number of positional plagiocephaly cases increased sixfold
from 1992 to 1994, occurring in approximately 33 out of every
10,000 births. This dramatic increase started when the
American Academy of Pediatrics (AAP) began its "Back to
Sleep" campaign, which continues to recommend that babies
sleep on their backs to reduce the risk of
sudden infant death syndrome (SIDS)
.
Since the AAP's campaign, the incidence of SIDS in the
United States has decreased by almost 40% while the incidence of
flattened head syndrome has risen. Still, the prevention of SIDS is
worth the increased risk of a flattened head, especially because
positional plagiocephaly will often correct itself with appropriate
intervention.
Causes of Positional Plagiocephaly
The most common cause of a flattened head is a baby's sleep
position. Because an infant sleeps so many hours on the back of his
or her head, the head sometimes assumes a flat shape.
Another thing that can contribute to flattening is torticollis,
which means the neck muscles are too tight, have inadequate tone,
or are shorter on one side than the other, causing the head to tilt
one way while the chin points in the opposite direction.
Premature babies
are more prone to positional plagiocephaly - their skulls are
softer than those of full-term babies, and they spend a great deal
of time on their backs without being moved or picked up because of
their medical needs and extreme fragility after birth, which
usually requires a stay in the
neonatal intensive care unit
.
A baby might even start to develop positional plagiocephaly
before birth, if pressure is placed on the baby's skull by the
mother's pelvis or a twin. In fact, it's not at all unusual
to see plagiocephaly in multiple birth infants.
But the differences in head shape seen in children with
positional plagiocephaly shouldn't be confused with those
caused by craniosynostosis, a more serious condition that occurs
when skull bones fuse together too soon, causing an abnormal skull
shape and possible brain damage if the condition is not corrected.
A child with craniosynostosis may have deformities in the front of
the head and a bony ridge over the abnormally fused skull bones.
Craniosynostosis is usually corrected with surgery.
Signs and Symptoms
Positional plagiocephaly is usually easy for parents to notice.
Typically, the back of the child's head (called the occiput)
and the ear on the flattened side may be pushed forward. In severe
cases, there may be bulging on the side opposite from the
flattening and the forehead may be asymmetrical (or uneven),
although this is unusual in full-term infants. If torticollis is
the cause, the neck, jaw, and face may be asymmetrical.
Diagnosis
Most often, a doctor can make the diagnosis of positional
plagiocephaly simply by examining your child's head, without
having to order lab tests or X-rays. The doctor will also note
whether regular repositioning of your child's head during sleep
successfully reshapes the growing skull over time
(craniosynostosis, on the other hand, typically will worsen).
If there's still some doubt, X-rays or a CT scan of the head
will show the doctor if the skull bones are normally separated or
if they fused together too soon. If the bones aren't fused, the
doctor will probably rule out craniosynostosis and confirm that the
child has positional plagiocephaly.
Treatment
Treatment for positional plagiocephaly caused by sleeping
position is usually easy and painless, entailing
simple repositioning of babies during sleep to encourage
them to alternate their head position while sleeping on their
backs.
Even though they'll probably move around throughout the
night, alternating sides is still beneficial. Wedge pillows are
available that keep babies lying on one side or the other, but be
sure to check with your doctor before using one to ensure that
it's appropriate and safe for your baby. The AAP does
not
recommend routinely using any devices that might restrict the
movement of an infant's head.
In addition, you may want to consider moving your baby's
crib to a different area of the room. If there's something in
the room (a window or toy, for example) that's catching your
baby's attention and causing him or her to hold the head in a
similar position day after day, moving the crib will coax your
child to look at it from another position.
Always be sure your baby gets plenty of supervised time on the
stomach while awake during the day. Not only does "tummy
time" promote normal shaping of the back the head, it also
helps in other ways. Looking around from a new perspective
encourages your baby's learning and discovery of the world.
Plus, it helps babies learn to push up on their arms, which helps
develop the muscles needed for crawling and sitting up. It also
helps to strengthen the neck muscles.
If torticollis is the cause of your baby's flattened head, a
course of
physical therapy
and a home exercise program will usually do the trick. A physical
therapist can teach you exercises to do with your baby involving
stretching techniques that are gradual and progressive. Most moves
will consist of stretching your child's neck to the side
opposite the tilt. Eventually, the neck muscles will be elongated
and the neck will straighten itself out. Although they're very
simple, the exercises must be performed correctly.
For kids with severe positional plagiocephaly, doctors may
prescribe a custom-molded helmet or head band. These work best if
started between the ages of 4 and 6 months, when a child grows the
fastest, and are usually less helpful after 10 months of age. They
work by applying gentle but constant pressure on a baby's
growing skull in an effort to redirect the growth.
But
never
purchase or use any devices like these without having your child
evaluated by a doctor. Only a small percentage of babies wear
helmets. The decision to use helmet therapy is made on a
case-by-case basis (for example, if the condition is so severe that
a baby's face is becoming misshapen or the parents are very
upset). Although helmets might not improve the outcome in all
children, some kids with severe torticollis can benefit from their
use.
Prognosis
The outlook for babies with positional plagiocephaly is
excellent. As babies grow, they begin to reposition themselves
naturally during sleep much more often than they did as newborns,
which allows their heads to be in different positions throughout
the night. After babies are able to roll over, the AAP still
recommends that parents put them to sleep on their backs, but then
allow them to move into the position that most suits them without
repositioning them onto their backs.
Most skull-flattening deformities are self-corrected by the time
the child is 1 year old. A persistent, severe, or cosmetically
obvious deformity can be corrected with reconstructive surgery
between 12 and 18 months of age, but very few cases require
this.
It's important to remember that plagiocephaly itself does
not affect your child's brain growth or cause developmental
delays or brain damage.
Prevention
Babies should be put down to
sleep
on their backs to help prevent SIDS, despite the possibility of
developing an area of flattening on the back of the head. However,
alternating their head position every night while they sleep and
providing lots of tummy time and stimulation during the day
while they're awake can reduce the risk of positional
plagiocephaly.
Reviewed by:
Steven Dowshen, MD
Date reviewed: February 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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