Normal Left / Positional Plagiocephaly Right
What is it?
“Positional plagiocephaly” (or deformational plagiocephaly) refers to an abnormal head shape that is caused by external pressure. When babies are born, especially in the first three months of life, their skull bones are soft and moldable. This allows them to fit through the birth canal, and the skull to adapt to the rapid brain growth that is occurring. However, this also means that if a baby frequently lays in the same position, the pressure on that part of the head will gradually change the overall shape of the head over time. This usually causes the back of the head to be flat on one side, with the forehead and the ear on that same side being pushed forward. We have seen an increase in plagiocephaly in recent years due to the “back to sleep campaign” which encourages parents to have their children sleep on their back rather than stomach to reduce the chance of sudden infant death syndrome. Positional plagiocephaly is also common in babies with torticollis. Torticollis occurs when your baby has tight neck muscles which make it hard for them to turn their head to one side. It can happen for various reasons, and is also quite common. We also see positional plagiocephaly more often in premature babies since they spend an extended period of time in the hospital, and do not move as much in the first few months of life.
If your child has an abnormal head shape, it is important to have them evaluated by an expert to determine the cause and differentiate it from something called “craniosynostosis”. If the cause does turn out to be positional plagiocephaly, it is a very treatable condition, and is not dangerous. Overall, issues are mainly related to the appearance of your child. However, research is showing that these children may also have a tendency for mild developmental delay, and should be followed very closely. When we see you in the office, we will perform a detailed physical exam to look for specific indicators of positional plagiocephaly. We also may order x-rays or a CT scan of your baby’s head to view the anatomy of the skull and confirm the diagnosis.
What treatment is available?
Making sure that your child is frequently moving and stimulated is the most effective technique for both treating and preventing positional plagiocephaly. This can be accomplished by ensuring that they are in many different positions throughout the day (hold them in different arms when you feed them, put them on your lap, put them in a car-seat or bouncy seat). They should also have daily “tummy time” which will improve muscle strength and encourage them to crawl and roll over. Babies should always sleep on their backs for safety, but you can make sure that they are turned from side to side (you can use a small blanket as a bump) so they are not always laying on the back of their head. If your baby also has torticollis, you will need to do special exercises to stretch out the tight muscles. Sometimes this even means going to physical therapy. In most instances, these techniques, along with the fact that your baby will spend less time laying down as it gets older, will allow the head shape to normalize over time. However, if the abnormality is more severe, or the head shape does not improve with the above maneuvers, your child may need helmet therapy.
What is helmet therapy?
A helmet is specifically designed for your child by an orthotist according to each unique head-shape. An orthotist specializes in creating prosthetics for all different parts of the body. We work very closely with the company Star Cranial. The orthotist will take special measurements and images of your baby’s head and make a helmet which is designed to gradually mold the head into its desired shape. Your baby must wear the helmet 23 hours a day, with breaks only for bathing and cleaning of the helmet. You will need frequent appointments with the orthotist because they will need to change the shape of the helmet or even make new helmets throughout the treatment period as your baby grows and the head shape changes. Usually your baby will need to wear the helmet for 6 months to a year to get the best result (usually worn till your child is about one year old). Since your baby will spend so much time in the helmet, it is possible to get them in custom designs and colors. Throughout the process, we will work closely with your orthotist and you to monitor progress and make sure that we are getting the desired result.
Will my child need surgery?
Positional plagiocephaly does not require surgery as long as treatment is begun early enough to change your child’s head shape while it is still growing. If your child is older, and the head shape is abnormal enough to cause concerns with appearance, surgery might be considered. The type of surgery would depend on what part of the head needs to be corrected and would be similar to the techniques referred to in the following sections on craniosynostosis.
“Positional plagiocephaly” (or deformational plagiocephaly) refers to an abnormal head shape that is caused by external pressure. When babies are born, especially in the first three months of life, their skull bones are soft and moldable. This allows them to fit through the birth canal, and the skull to adapt to the rapid brain growth that is occurring. However, this also means that if a baby frequently lays in the same position, the pressure on that part of the head will gradually change the overall shape of the head over time. This usually causes the back of the head to be flat on one side, with the forehead and the ear on that same side being pushed forward. We have seen an increase in plagiocephaly in recent years due to the “back to sleep campaign” which encourages parents to have their children sleep on their back rather than stomach to reduce the chance of sudden infant death syndrome. Positional plagiocephaly is also common in babies with torticollis. Torticollis occurs when your baby has tight neck muscles which make it hard for them to turn their head to one side. It can happen for various reasons, and is also quite common. We also see positional plagiocephaly more often in premature babies since they spend an extended period of time in the hospital, and do not move as much in the first few months of life.
If your child has an abnormal head shape, it is important to have them evaluated by an expert to determine the cause and differentiate it from something called “craniosynostosis”. If the cause does turn out to be positional plagiocephaly, it is a very treatable condition, and is not dangerous. Overall, issues are mainly related to the appearance of your child. However, research is showing that these children may also have a tendency for mild developmental delay, and should be followed very closely. When we see you in the office, we will perform a detailed physical exam to look for specific indicators of positional plagiocephaly. We also may order x-rays or a CT scan of your baby’s head to view the anatomy of the skull and confirm the diagnosis.
What treatment is available?
Making sure that your child is frequently moving and stimulated is the most effective technique for both treating and preventing positional plagiocephaly. This can be accomplished by ensuring that they are in many different positions throughout the day (hold them in different arms when you feed them, put them on your lap, put them in a car-seat or bouncy seat). They should also have daily “tummy time” which will improve muscle strength and encourage them to crawl and roll over. Babies should always sleep on their backs for safety, but you can make sure that they are turned from side to side (you can use a small blanket as a bump) so they are not always laying on the back of their head. If your baby also has torticollis, you will need to do special exercises to stretch out the tight muscles. Sometimes this even means going to physical therapy. In most instances, these techniques, along with the fact that your baby will spend less time laying down as it gets older, will allow the head shape to normalize over time. However, if the abnormality is more severe, or the head shape does not improve with the above maneuvers, your child may need helmet therapy.
What is helmet therapy?
A helmet is specifically designed for your child by an orthotist according to each unique head-shape. An orthotist specializes in creating prosthetics for all different parts of the body. We work very closely with the company Star Cranial. The orthotist will take special measurements and images of your baby’s head and make a helmet which is designed to gradually mold the head into its desired shape. Your baby must wear the helmet 23 hours a day, with breaks only for bathing and cleaning of the helmet. You will need frequent appointments with the orthotist because they will need to change the shape of the helmet or even make new helmets throughout the treatment period as your baby grows and the head shape changes. Usually your baby will need to wear the helmet for 6 months to a year to get the best result (usually worn till your child is about one year old). Since your baby will spend so much time in the helmet, it is possible to get them in custom designs and colors. Throughout the process, we will work closely with your orthotist and you to monitor progress and make sure that we are getting the desired result.
Will my child need surgery?
Positional plagiocephaly does not require surgery as long as treatment is begun early enough to change your child’s head shape while it is still growing. If your child is older, and the head shape is abnormal enough to cause concerns with appearance, surgery might be considered. The type of surgery would depend on what part of the head needs to be corrected and would be similar to the techniques referred to in the following sections on craniosynostosis.
