Plagiocephaly On The Rise

By Robynne Elkin, MOT, OTR/L, CKT

Have you ever wondered why we are seeing an increased number of infants wearing helmets? The American Academy of Pediatrics (AAP), SIDS Alliance, and U.S. Public Health Service introduced a campaign in 1994 to help combat sudden infant death syndrome (SIDS). The Back to Sleep campaign has helped to reduce infant mortality rates since its inception. However, it has often been cited as the reason for the recent increase in the number of infants developing deformational plagiocephaly or flattened head syndrome.

Other factors that also increase the risk of developing plagiocephaly include a multiple birth pregnancy (as the babies "squash together" in the womb), prematurity, poor muscle tone and a condition known as oligohydramnios which is insufficient fluid in the womb to cushion the baby, and torticollis, also known as wryneck. With torticollis, an infant experiences neck stiffness caused by tightened muscles and decreased head movement, which in turn can cause head flattening. Nearly 15 to 25% of plagiocephalic children have torticollis. In addition, frequent use of car seats, infant carriers, bouncy seats, and infant swings also contribute to a misshapen head.

Plagiocephaly Symptoms

Plagiocephaly may be apparent at different ages depending on the cause. Some babies can be born with a flat head due to the baby's passage down the birth canal. This is most often a temporary condition, but occasionally it does not resolve right away. Other babies develop plagiocephaly later as the bones of the skull fuse. The abnormal shape can best be seen if you look down on the baby's head from above, or take an aerial view as I common tell my parents.

Symptoms of plagiocephaly include:

Bald spot on the flattened side of an asymmetrical head

Eyes appearing to have unequal positioning

Flattening on one side of the back of the head with a compensatory bulge in the forehead on the same side

A parallelogram-shaped head when viewed from above

Problems Caused by Plagiocephaly

There is debate of whether there are any functional or developmental issues associated with untreated plagiocephaly. A strong motive for pursuing treatment is the concern that functional problems could occur later in life as the result of residual cranial deformity. These problems can involve

Vision

Hearing

The temporomandibular joint (TMJ)

Developmental delay

Craniosynostosis (very unlikely) - a condition where the sutures of the skull close prematurely forming a ridge. The child must have surgery of the skull so the brain can grow normally.

Despite these concerns, there is no conclusive evidence demonstrating a relationship between functional problems and untreated plagiocephaly. Parents mainly pursue helmets for their infants for cosmetic reasons. A small percentage of children require a helmet truly because of one of the problems listed above.

Plagiocephaly Treatments

It is possible to prevent positional plagiocephaly by changing your newborn's resting position frequently. As a therapist, I advise my parents to do all of the following:

Alternate the position or direction of your baby's head when he/she is sleeping.

The AAP recommends at least 15 minutes of tummy time daily. This will take the pressure off the back of the skull.

Carry your baby in a position where he/she can turn and look in both directions.

Dry or change your baby while they are on their tummy.

Allow your infant to take a supervised nap on their tummy to allow for better head molding.

Switch between putting them in a bouncy seat, car seat, sling, or on a flat surface so there is no constant pressure on one area of the skull.

If you are using a positioning wedge be sure it is designed to prevent plagiocephacly, both by having a proper head molding "cutout" where the baby lies on his back and having a specially designed "tummy time" option.

Plagiocephaly Helmets

When the treatments mentioned above are not practiced and plagiocephaly is significant, a helmet may be prescribed by a craniofacial specialist. Helmets should be fitted at 4-8 months when an infant's head is the most malleable. They are worn, on average, for 2-3 months. Most helmets are not covered by insurance because of cosmetic reasons. The insurance company feels it is the parents who are responsible for making sure their babies are positioned properly.

About the Author

Robynne Elkin, MOT, OTR/L, CKT is a pediatric occupational therapist who lives with her husband and two children in Frisco, TX. She specializes in working with infants and toddlers who have dysphagia, GERD, and pediatric feeding disorders. Robynne has worked and consulted in Neonatal Intensive Care Units (NICU), helped to develop an outpatient hospital-based feeding program and modified barium swallow study program, and consults with parents in the Ask the Experts message board at www.infantrefluxdisease.com. Robynne enjoys lecturing about feeding disorders to infant intervention therapists, parents, and medical professionals in her spare time. She currently consults with families in a hospital setting and works in 2 NICUs. Her mission is to help support the family with bringing back the fun, joy, and family connection in eating and sleeping peacefully.