Parents of newborn children have a lot of things to worry about, one of these concerns is positional otherwise known as “flat head”. Most of the time plagiocephaly is related to head positioning, however a small percentage of the time plagiocephaly can be a result of a more serious condition referred to as craniosynostosis. In this article we will discuss positional plagiocephaly which refers to an abnormal head shape that develops as a result of positioning in cribs, strollers, car seats, etc.. A common question we are asked is whether or not it will go away on its own. In this blog post we will answer this important question.
The first thing to know is what causes plagiocephaly. Almost all children with positional plagiocephaly have some form of neck instability or neck imbalance referred to as torticollis. When a child with torticollis lays their head down they tend to favor one side over the other. The combination of torticollis and positioning with pressure on the back of the head is the major cause of plagiocephaly. There are several potential causes of pressure on the back of the head in infants. One cause is back sleeping. If a baby frequently sleeps on their back without changing positions, they will often develop flat head. However, it is crucial that the baby sleeps on their back for the first year of their life to prevent SIDS. The same issues arise with positioning in strollers, car seats, etc. In addition children who are born prematurely are also more prone to plagiocephaly as the skull bones tend to be softer than full-term babies and preemies also tend to spend time laying in their incubators and NICU beds without switching positions. It is important to remember that plagiocephlay does not mean anything was done wrong, it actually happens from following the “back to sleep” rules to prevent SIDS (Sudden Infant Death Syndrome).
Some cases will go away on their own with simple repositioning instructions and tummy time. However, it is hard to determine which cases will resolve on their own and which cases will require intervention. By waiting without intervention the window of opportunity may be missed. The most important step is to consult with a pediatrician who is up to date with the current American Academy of Pediatrics Guidelines or consult with a plagiocephaly expert at or before 8 weeks of age. At 8 weeks a full evaluation for plagiocephaly and torticollis should be performed to determine the best course of action. If there is no torticollis and mild plagiocephaly then a course of home repositioning and tummy time may be appropriate. However, in order to avoid the need for a helmet, many times physical therapy is recommended.
Below are the official guidelines for physical therapy and torticollis endorsed by the American Academy of Pediatrics:
1. Physical therapy is recommended over repositioning education alone for reducing prevalence of infantile positional plagiocephaly in infants 7 weeks of age.
2. Physical therapy is as effective for the treatment of positional plagiocephaly and recommended over the use of a positioning pillow in order to ensure a safe sleeping environment and comply with American Academy of Pediatrics recommendations.
1. Helmet therapy is recommended for infants with persistent moderate to severe plagiocephaly after a course of conservative treatment (repositioning and/or physical therapy).
2. Helmet therapy is recommended for infants with moderate to severe plagiocephaly presenting at an advanced age. (this is typically after 6 months of age)
When you hear plagiocephaly, it does sound scary. Fortunately, there are several treatment options and, if you are proactive, you may avoid the need for helmet therapy.