When your child is born, the skull bones are very soft and susceptible to displacement. This can result in an abnormal head shape called positional plagiocephaly. There is a lot you can do to help your child’s head take on a more normal shape. The first step is to visit Up Pediatric Plastic Surgery where Shitel Patel, MD, and Jacqueline Wegge, MD, are available for diagnosis and treatment. If you’re in Houston or Webster, Texas, call or schedule an appointment online to get started.
Positional plagiocephaly, or deformational plagiocephaly, refers to an abnormal head shape that’s caused by external pressure. During your baby’s first three months, the skull bones are soft and moldable, which helps them to fit through the birth canal and allows the skull to adapt to the rapid brain growth that’s occurring.
However, this also means that if your baby frequently sleeps in the same position, the pressure on that part of the head can gradually change the overall shape of your child’s head over time. This usually causes the back of the head to be flat on one side, while the forehead and the ear on that same side are pushed forward.
It is quite common for babies to be diagnosed with an abnormal head shape during the first year of life. Sometimes this may be present from the moment your baby is born, it may be something that you as parents notice as you watch your child grow, or it may be something that your pediatrician points out. In these situations, it is important to figure out whether these changes to your child’s head are related to the way their skull is growing (craniosynostosis), or if it is just a result of the way they have been positioned while sleeping (positional plagiocephaly). In many of these instances, you will be referred to see a plastic surgeon specializing in craniofacial surgery. We help you figure out the cause of the problem, as well as what your options are for treating it.
At Up Pediatric Plastic Surgery, the doctors 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 backs to reduce the chance of sudden infant death syndrome.
Positional plagiocephaly is also common in babies with torticollis. Torticollis occurs when your infant has tight neck muscles, which make it hard to turn the head to one side.
Positional plagiocephaly is more prevalent in premature babies, as well, since they spend an extended period of time in the hospital and don’t move as much in the first few months of life.
If your child has an abnormal head shape, it’s important to have the doctors at Up Pediatric Plastic Surgery determine the cause and perform a detailed physical exam to look for specific indicators of positional plagiocephaly. The doctor may order X-rays or a CT scan of your baby’s head to view the anatomy of the skull and confirm the diagnosis.
Making sure your infant is frequently moving and stimulated is the most effective technique for both treating and preventing positional plagiocephaly. This can be accomplished by ensuring that your child is in many different positions throughout the day. You can hold them in different arms when you feed them, put them on your lap, or put them in a car seat or bouncy seat.
Your child should also have daily “tummy time,” which improves muscle strength and encourages crawling and rolling over. Babies should always sleep on their backs for safety, but you can make sure that they’re turned from side to side (you can use a small blanket as a bump) so they’re not always lying on the back of their head.
If your baby also has torticollis, you need to do special exercises to stretch out the tight neck muscles.
In most instances, these techniques, along with the fact that your baby spends less time lying down as they get older, allows their head shape to normalize over time. However, if the abnormality is more severe, or the head shape doesn’t improve with the above maneuvers, your child may need helmet therapy.
With helmet therapy, your doctor at Up Pediatric Plastic Surgery orders a helmet specifically designed for your child by an orthotist. The orthotist takes special measurements and images of your baby’s head and makes a helmet, which is designed to gradually mold your child’s head into a more natural shape.
Your baby must wear the helmet 23 hours a day, with breaks only for bathing and helmet cleaning. You need frequent appointments with the orthotist, because they need to change the shape of the helmet, or even make a new helmet, throughout the treatment period as your infant grows and their head shape changes.
Usually, your baby needs to wear the helmet for six months to a year to get the best result. Since your baby spends so much time in the helmet, it’s possible to get them in custom designs and colors.
Throughout the entire process, your doctor works closely with you and your orthotist to monitor progress and make sure that you’re getting the results you want.
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.
If you suspect your child may have positional plagiocephaly, call Up Pediatric Plastic Surgery, or use the online booking form to schedule a consultation.