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In recent years, the practice of sleeping babies on their backs to prevent sudden infant death syndrome (SIDS) has resulted in a rise in the number of cases of plagiocephaly (otherwise known as flat head syndrome). Bubbaroo is passionate about safe sleep practices and communicating the safe sleep message. Our goal is to help baby to sleep safely! You can read more about Red Nose (formerly SIDS & Kids) in our blog here. We hope to educate and assist new parents in identifying and preventing plagiocephaly wherever possible.
What Is Plagiocephaly?
Deformational (or positional) plagiocephaly means that baby has a misshapen (asymmetrical) head shape. It is also known as flat head and is usually caused by pressure on one part of the head, causing it to flatten. This can happen antenatally due to the position of the baby in the uterus or postnatally due to the fact that babies have very malleable, soft skull bones. Another form of Plagiocephaly (Synostotic) refers to an early fusion of the cranial sutures that prevents symmetric brain and cranial growth. This requires immediate attention from a Paediatrician to correct via surgery.
How to Check Plagiocephaly?
If you feel that your baby’s head may be developing an unusual shape take time to do a check. Firstly, view your baby’s head from different angles: top, side, face and rear. Check the alignment of your baby’s ears. If you notice that baby’s head shape is not looking quite right then see your doctor.
Why Does Plagiocephaly Occur?
A
ccording to the Department of Plastic and Maxillofacial Surgery at the Royal Children’s Hospital in Victoria, “there are several reasons why a baby may have deformational plagiocephaly.
These include:
Back sleeping
Infants who sleep on their backs and/or in car seats without alternating their position are at increased risk of deformational plagiocephaly.
Muscular torticollis
This is a congenital condition caused by shortening or tightening of one or more of the neck muscles. This causes the infant’s head to tilt and/or turn to favour one particular direction.
Prematurity
The cranial bones of premature infants are very soft and malleable following birth, and therefore more susceptible to external pressures.
In utero constraint
Less frequently, a baby is born with a flattened skull due to a restricted intrauterine environment or ‘crowding’ (i.e. multiple births, breech position, small maternal pelvis),”.
Parental Awareness
In many cases, the parent is the one who notices that the baby has a flat head at the back or side or if the baby’s forehead or ears are not aligned. In other cases, a health professional will pick it up. You will certainly need a medical diagnosis to access some forms of treatment. If your baby’s head seems unusual by around 6 – 8 weeks of age you should consult your doctor or paediatric physiotherapist. Don’t wait for it to correct itself, seek professional advice as soon as possible.
Positioning
Positioning is an important factor in the cause of plagiocephaly. Perhaps you may have noticed that your baby has developed a preference for turning their head to one side. Baby may need assistance from you to correct this and even out any favouritism to one side. This may be a result of the position in the cot or during play time. Positioning baby the same way in a cot will result in baby naturally following the light and turning their head to the same side all the time. Therefore it is important to place baby to sleep in different positions in the cot.
You should always continue to place baby on their back to sleep according to SIDS guidelines. However, you can vary which end of the cot you place their head. try alternating ends of the cot each night. Then baby is forced to turn their head to the opposite side to follow the light or noise. You can also try moving furniture around the room so that baby is turning to look and different sources of light and interest.
The critical issue here is age. Repositioning your baby’s head is most effective between birth and 4 months. Monitor your baby and keep track of their head shape. Plagiocephaly can be fixed if addressed in infancy. However, it cannot always be fixed with an older child.
Tummy Time
I cannot stress the importance of tummy time highly enough. Tummy time is a great way to counteract the large amount of time that babies spend in the supine position (back down). Our blog on tummy time may give you some ideas to ensure that baby is getting the maximum amount of tummy time per day. Carrying baby in a baby carrier or in the upright position sometimes, rather than using the pram, could also assist with reducing the amount of pressure on the baby’s head. The techniques that prevent plagiocephaly are also used in the correction procedure.
Baby Carrying
Regularly carrying your baby in a sling or carrier can help take some of the pressure off your baby’s head. Holding your baby upright or over your arm can also help to strengthen their back and neck muscles and take pressure off their head.
In recent years increased time in car seats, baby rockers and swings has also contributed to the increase in the rise of Plagiocephaly. Car seats should only be used for transport so try to keep sleeping in care seats to a minimum.
Plagiocephaly – Treatment
If your baby is diagnosed with plagiocephaly, treatment will vary depending on the severity of the case. The good news is that many cases of deformational plagiocephaly can be corrected with intervention. Often there will be no long term problems. Department of Plastic and Maxillofacial Surgery at the Royal Children’s Hospital in Victoria suggests that some cases may correct spontaneously when the infant begins to sit. However, the experts state that an early diagnosis of torticollis is very important. Treatment will be required by a paediatric physiotherapist.
The Use of a Helmet
A helmet is usually NOT recommended for mild cases of plagiocephaly. It may not always be necessary to use a helmet to correct the problem, only for severe cases of plagiocephaly require this treatment where physiotherapy and repositioning has not improved the child’s plagiocephaly.
Plagiocephaly – Tyler’s Story
One of our Bubbaroo customers Natasha has shared her personal experience when her first child Tyler developed plagiocephaly. Natasha says, “he was diagnosed with plagiocephaly at just 4 months old. What lead to this was Tyler favouring the right side of his face during sleep which affected the shape of his skull and tightened the muscles in his neck. As the muscles were tight it was uncomfortable for Tyler to turn his head to the left”.
Initial Physiotherapy
“Tyler started seeing a physiotherapist on a weekly basis to assist with loo
sening his neck muscles and we were given exercises to continue at home. When Tyler was 6 months our therapist advised we should consider helmet therapy because his head shape was not improving. The helmet helps to reshape the skull by taking the pressure off the flat area, allowing the affected area to grow into the space provided. There was also a time frame for helmet therapy as the best results occur between 5-8 months of age due to head growth”.
Starting Helmet Therapy
Natasha was adamant that she wanted to proceed with helmet therapy. She was keenly aware that it might not be an easy regime – 23 hours a day wearing the helmet, as long as required. “My husband and I decided to proceed with helmet therapy after researching other cases similar to Tyler’s. We were referred to a specialist to have the helmet made. The helmet didn’t affect Tyler on a day to day basis or his sleep. We had regular visits to our specialist and we could see the incredible results due to computer technology. Tyler wore the helmet for 3 months. It was the best decision we made”, says Natasha.
Advice for Parents
After her personal experience, Natasha recommends that new parents keep an eye on their little one’s head movements. If baby seems to be favouring a particular side, include regular head rotations during sleep, lots and lots of tummy time. Also try to avoid long periods in car seats, swings and bouncers. The good new is that Tyler’s head has developed normally. “Now looking at Tyler you would never know he suffered from plagiocephaly”, Natasha says.
Be Aware
In conclusion, the main message from health professionals is to identify and address the problem as early as possible. Remember tummy time from birth. If you have any concerns about your baby’s head shape or development, please see your doctor or health professional. A health professional must diagnose plagiocephaly. Early intervention is recommended in order to maximise the possible growth correction. Babies heads develop so much in the first 12 months of life. It really is essential to try to correct the problem during this very important stage of growth. Chances are if identified early your baby’s head shape will improve with growth and time.
