Plagiocephaly occurs when a flat spot develops on one side of the baby’s head or the back of the head. It usually happens when a baby consistently sleeps in the same position, which can occur with back sleeping and car seat sleeping. There are, however, other scenarios that can lead to the development of this abnormal skull shape:
- A tight space in the uterus, which is common in pregnancies of twins or other multiples.
- Muscular torticollis, a congenital condition in which the neck muscles are extremely tight, forcing the baby’s head to stay in one position.
- Premature birth, which result in babies with softer skulls who, after birth, typically spend a lot of time in the hospital on respirators with their heads in the same position.
Diagnosis
Plagiocephaly is very common and can typically be diagnosed with a thorough physical evaluation by a clinician who specializes in treating craniofacial deformities. Because the condition looks similar to craniosynostosis, accurate diagnosis by an experienced team is extremely important to managing your child’s condition.
The experts at the North Carolina Cleft and Craniofacial Center will be able to differentiate readily between these conditions. In rare cases, our medical team may use a CT scan to confirm the diagnosis and further evaluate your child’s condition. It is important that cases of craniosynostosis be identified early, as these conditions often require surgical treatment, and if left untreated, may result in elevated pressure in the skull.
Treatment
In most babies with plagiocephaly due to sleeping position, simple repositioning of the child will resolve the problem.
If repositioning is not successful in addressing the problem, or if the deformation is severe and lasts longer than six months of age, helmet therapy may be required.
Helmet therapy works by fitting the skull tightly with a specially designed helmet in all areas except where it is flat. Leaving extra room around the flat area of the head allows the skull and brain to grow back into their normal shape.
Plagiocephaly can be associated with torticollis, or a tight neck, and can be seen when there are structural anomalies, such as fused or hemivertebrae, or most commonly as a completely isolated anomaly.
In the majority of cases, physical therapy to straighten and stretch the neck will correct the head shape and posture, but in more severe cases, helmet therapy can be used.
Protective Helmets
- When will my child start wearing the helmet? Typically the protective helmets are fitted at the time of discharge from the hospital.
- How many hours each day should the helmet be worn? The helmet will need to be worn in a car or around around other children any time an injury could occur.
- Can my child resume normal activities? Your child will need close supervision and should avoid rough activities until the bones heal. If your child is walking or crawling at time of surgery or if around other small children a protective helmet will be provided to use until the bones have a chance to heal which is typically 3 months for the children who have spring cranioplasty. Once most of the bony defect has healed which is typically 4-6 months after placement, the springs will be removed in a small outpatient surgical procedure and no protective helmet will be required.
Frequently Asked Questions
The exact effects of untreated plagiocephaly are unknown although medical evidence suggests that plagiocephaly should not be considered purely cosmetic. Some of the concerns include: continued skull asymmetry and/or disproportion, facial asymmetry, problems from jaw misalignment, disruptions to visual fields, difficulty fitting eyewear, poorly fitting safety helmets and neck muscle asymmetry.
Repositioning and tummy time are considered to be conservative treatment options. These are most effective in very young infant up to about four months of age and can reduce the severity and improve the overall head shape in some cases. Repositioning and tummy time can be discussed with your pediatrician and/or therapist. An orthotist can be involved to make a cranial scan or anthropometric measurements to document the current head shape. Over time, another scan or measurement series will compare the changes and determine if a helmet is needed.
Many babies are born with neck and trunk tightness or weakness that create positions of comfort or preferred postures. Torticollis is another common condition that is caused by an imbalance of the neck muscles and prevents full turning of the head to both sides. Preferred postures may lead to neck tightness and may increase time spent in these positions. These situations may be resistant to repositioning and cause the infant some distress during tummy time. It is important to understand that flattening of the head, preferred postures, neck imbalance, resistance to tummy time and repositioning should be discussed with your pediatrician.
