Positional Plagiocephaly

Please note before you read on, that I am not a health care provider, and the information I have placed on this page is gathered through information from The Stollery Children's Health Center Plagiocephaly Pamphlet as well as from CAPPS KIDS. You should always talk to your health care provider before following any advice.

• What is it? • How is it caused? • Repostional Therapy and Prevention • Helmet Therapy • Talking to a health care professional •

What is it?

Positional Plagiocephaly is the medical term for the head shape caused by lying in one position. A baby with this head problem, may have a Flat Area on the head, one ear the sticks out and facial changes. Certain facial changes, if severe, can lead to future problems such as problems with chewing and eating. Difficulty with vision could also become an issue and require corrective surgery to repair. As well it can possibly cause temporormandibular joint syndrome (The temporormandibular joint or TMJ is the joint that operates the jaw). Click here to see examples of positional plagiocephaly.

How is it caused?

Flat areas on a baby's skull develop because the skull bones are soft until about 1 year of age.

• The Birth
Few newborns have perfectly shaped heads. It may take up to 6 weeks for your baby's head to become rounded after birth. However, after 6 weeks if the deformity is still noticeable it could be plagiocephaly.

• In Utero Constraint
When a baby develops in a womb that is constricted it can lead to Positional Plagiocephaly. Constriction of the womb can be caused by a variety of factors including, a multiple pregnancy with two or more fetuses, a small or malformed uterus, a small maternal pelvis, or an inappropriate amount of amniotic fluid. A baby that is in a breech position can also develop Positional Plagiocephaly if the baby’s head becomes wedged under the mother’s ribs.

• Prematurity
The skull of a premature infant can be very soft and malleable making the head more susceptible to remolding due to external pressures.

• Back Sleeping and Tummy Awake Time
The most common cause is due to babies lying in one position for long periods of time. Babies whom develop this flat area usually turn their heads to one side while they are lying on their backs. These babies may also keep their heads in the same position when sitting in their car seat or swing. Some babies prefer this head position even before they are born. Other babies keep their heads to one side because of a neck muscle problem called Congenital Muscular Torticollis. In 1992 the American Academy of Pediatrics’ (AAP) made the recommendation that infants should sleep on their backs to reduce the risk of SIDS (Sudden Infant Death Syndrome), which launched the “Back To Sleep Campaign”. While the Back to Sleep Campaign has made tremendous strides in reducing SIDS, there has also been a dramatic increase of the number of infants suffering from Positional Plagiocephaly due to back sleeping

.***THIS IS VERY IMPORTANT. Due to SIDS, it is very important that your child still be placed on his or her side or back while sleeping to reduce the risk of SIDS as studies have shown SIDS to have dropped dramatically since the campaign started, however during supervised "awake" periods, your child should spend as much time as possible on their sides or tummy to help prevent Positional Plagiocephaly.***

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Treatments

• Repositional Therapy & Prevention

The best way to deal with Positional Plagiocephaly is to try to prevent it if possible, and when first noticed to try and treat it with repositioning.

Here are some things you can do to prevent a flat area on your baby's head.

• Vary your baby's head position during sleep, e.g. side-to-back-to-side.
• Change toy, mobile, and crib positions regularity so that your baby does not always look in one direction
• Provide supervised "tummy time" and side-lying time when your baby is awake.
• Use toys designed for tummy and side playing
• See your doctor if you notice that your baby always turns or tilts the head to one side. Your baby may need neck stretching exercises.

If your baby is already showing signs of positional plagiocephaly, you can try repositional therapy. Please talk to your health care provider to ensure these are the best therapies for your child.

1. Note the times when your baby is on the flat area.

• When your baby is sleeping?
• When you are holding or carrying the baby?
• When your baby is in the car seat, swing or bouncy chair?
• When your baby is playing
• On your baby's change table?
• Other?

2. Position your baby off the flat spots. Here are some positioning tips for different times.

Sleeping

• Place a small rolled up blanket under the shoulder of the same side of the flat area. Change the location of toys, mobiles and the crib so that the baby turns to the other side of his or her crib.

Playing

• "Tummy Time" is a great way for your baby to be positioned when he or she is awake. If you haven't given your baby tummy time from the time he or she was born, and this is the first time, your baby may not like it and it may take some time to get used to it. Keep trying! Tummy time also helps to develop shoulder and arm muscles! Remember to tell your family members, baby-sitters and daycare workers about your repostional therapy so they do it too!

Carrying or Holding

• Switch your baby to your opposite arm when holding. If you bottle feed, change to the other side.

Car Seat, Swing or Bouncy Chair

• Try to limit the time your baby spends in the car seat, swing or bouncy chair. Change the location of the car seat in your car to the other side.

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Helmet Therapy

If none of the above seem to be working by the time your baby is 4-6 months of age, then your baby may need a little help. Your health care provider may send you to a specialist who may recommend helmet therapy.

The first corrective device offered for Positional Plagiocephaly was the Molding Helmet. The original molding helmet introduced in 1979 was designed with the basic concept that if you surround the asymmetrical infant head with a symmetrical (normal) mold, the skull will grow into the mold and take on the shape of the mold resulting in a normal shaped head. An alternative technique, Dynamic Orthotic CranioplastySM (DOC Band®), was subsequently developed as a more proactive approach to treatment of Positional Plagiocephaly. In this technique, the device was specifically designed to apply gentle pressure to the area of the head where growth was not wanted, while leaving space where growth was needed. With this technique, the child is seen on a weekly to biweekly basis to have adjustments made to the band to ensure proper growth of the head and optimum correction of the deformity. Today we are seeing a large variety of bands and helmets, many of which take into consideration the concepts of the original molding helmets and the DOC Band®. The child’s physician will be able to direct parents on where to obtain a helmet or band. It is important that parents research the success rate of any helmet or band under consideration. If a particular helmet or band does not have a good success rate then another should be found.

Bands and Helmets come in several different designs but two things that they all have in common is that they are all lightweight and they are all custom made to fit the individual baby’s head. In order for the band or helmet to be custom fit there must be a casting done of the child’s head. For more information on the casting process and to see pictures of an actual casting, please visit Caps2000's Casting Section: http://www.cappskids.org/CastingProcess.htm

The length of treatment time for a helmet or band is dependent on several things. The age at which the baby starts the therapy, the particular design of the band or helmet used, the rate at which the individual baby grows, and the degree of Positional Plagiocephaly all play factors into determining the length of treatment necessary. Therefore, it cannot be stated how long therapy will last for an individual baby. However, on average most children will complete therapy within 2- 6 months, but again this is only an average and it is possible for an individual baby to complete therapy earlier or later depending on the factors listed above.

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Talking to a Health Care Professional

If you are worried about your baby's head shape after six weeks of age, talk to your doctor or a public health nurse. Your baby may need to a specialist. It is very important that if the head remains flat after attempts at repositional therapy, that your child sees a specialist, such as a pediatric neurosurgeon.