Heads come in all shapes and sizes.
…But what is considered normal versus abnormal, and when is it a concern?
In the office we see many babies with flattening to one side of the head- this is known as plagiocephaly. Brachycephaly, on the other hand is when the back of the head is flattened.
There are many reasons that an infant may have some degree of plagiocephaly or brachycephaly. They include:
1. Positional (outside of the womb)- This is most common. As pediatric providers, we emphasize the importance of putting your baby on his or her back to sleep in order to reduce the risk of SIDS (Sudden Infant Death Syndrome). With more time on their backs, babies may develop some flattening of the head. Many babies will develop some form of plagiocephaly due to their positioning during sleep, or even while awake.
2. Positional (inside of the womb)-Sometimes babies are cramped for space within the womb, especially if there are twins in there! These babies may have misshapen heads due to the lack of space.
3. Torticollis-This occurs when the sternocleidomastoid muscle (the muscle on the side of the neck) is tight or shortened. This causes a head tilt in your baby. Babies with torticollis tend to favor one side, causing flattening of one side of the head.
4. Extended hospital stay and/or prematurity-If your baby had an extended stay at the hospital or in the neonatal intensive care unit (NICU), he or she may have acquired plagiocephaly or brachycephaly. While in the NICU, babies are sometimes positioned in a certain way due to feeding tubes, IVs etc. Premature infants also have softer skulls, making it more likely to develop a flat spot.
5. Congenital plagiocephaly (craniosynostosis)-Craniosynostosis is considered a birth defect, meaning he or she was born with it. Although this is rare, it is important to bring up, as if it is left untreated it can cause serious complications. We will discuss more about this type later.
**After reviewing the reasons for misshapen heads above, I want to note that MOST cases of plagiocephaly are harmless and do not lead to severe complications. When in doubt, have your child's provider evaluate at the next visit.
What are the symptoms?
· Misshapen or flattened head
· Asymmetrical appearing facial features
· Uneven appearing ears
· Bulging forehead
How can we prevent plagiocephaly or brachycephaly?
· Supervised tummy time throughout the day
· Change position of toys/mobiles etc.
· Alternate the arm you use to hold or carry your baby
· Limit the amount of time your baby is in a car seat, bouncy seat, or on his or her back during awake hours when possible
I’ve seen babies wearing helmets for plagiocephaly. What is the purpose of them?
A cranial orthotic helmet might be suggested and prescribed for your infant in order to treat his or her plagiocephaly or brachycephaly. These helmets are fitted and frequently re-fitted to help correct the shape of the head. They work by redirecting the growth of the skull and are worn for most of the day (typically 23 hours/day). Being referred early is key-starting treatment with a cranial orthosis between 4-6 months is ideal, as this is when the head grows rapidly. Average treatment time is 1-4 months but can vary depending on the case.
What does NOT work and should be avoided?
Pillows, wedges, and other unsafe sleep devices- These devices are not recommended and should not be used. Your infant should be sleeping on his or her back on a firm crib mattress WITHOUT pillows, blankets, toys, or crib bumpers in order to reduce the risk of SIDS.
Who should I see?
First, make an appointment with your child’s pediatric provider for a full evaluation. He or she may refer your child to a physical therapist, occupational therapist, a specialized clinic for plagiocephaly, geneticist, neurosurgeon, or a craniofacial specialist depending on the physical exam. If the plagiocephaly is mild, no further treatment is typically necessary.
More on Craniosynostosis
This is when the plates of the skull fuse early or abnormally. The first sign is typically an abnormal head shape or uneven facial features. You may also notice that the child's soft spot on the top of the head is full-appearing. Growth is restricted in some of the areas of the skull, while other parts of the skull continue to grow, causing a misshapen head. Diagnosis is typically based on physical exam and imaging (x-ray or CT scan). Craniosynostosis requires prompt evaluation and treatment, as it can restrict brain growth and cause an increase in intracranial pressure. Craniosynostosis typically requires surgery.
PLEASE NOTE: This is different from positional plagiocephaly as described above and will not correct itself.
Again, when in doubt, please make an appointment with your child's pediatric provider.
Until next time,