Plagiocephaly

Plagiocephaly refers to the condition where a baby develops a flat spot on the back or on the side of their head. This usually develops when a child sleeps in the same position for majority of the time or prefers to look towards one direction when laying on their back. There are two type of plagiocephaly:

1. Positional plagiocephaly: this is the most common type seen in babies. This is typically caused by their sleeping position on their back but can also be caused by their positioning in car seats, carriers, and other infant equipment. Conditions such a torticollis, which is shortening of one side of a baby’s neck leading to a head tilt, can be associated with plagiocephaly.
2. Congenital plagiocephaly: this is caused by the closing of the coronal suture on top of a baby’s head. The skull consists of several pieces of flat bones that are connected by sutures (need to find a better way to articulate this). During infancy, sutures remain loosely connect and begin to fuse at different times between 3 to 9 months of age.  If these sutures begin to fuse prematurely resulting in a known as craniosynostosis, this can result in plagiocephaly and have impacts on brain development.  Depending on the severity of their condition, this may require more invasive correction like surgical intervention.
   

How Is It Assessed
Your child’s pediatrician will conduct head symmetry assessments by looking at your baby’s head shape in multiple planes, such as a top view, a front view, and side view. Your child’s pediatrician may also assess their neck range of motion. They may be able to determine if your child’s plagiocephaly is associated with torticollis if a head preference starts to emerge.  Other signs of plagiocephaly will involve facial asymmetries such as one ear appearing to be “pushed forward”, bulging forehead on one side, and uneven positioning of eyebrows, cheekbones, and jaw.

Importance of Early Detection
Plagiocephaly may be associated with other conditions, such a torticollis, and developmental delay, that can need to be address by your medical and physical therapy team. If your baby’s head shape is not corrected following several weeks of conservative treatment, a helmet may be recommended by your pediatrician. In infants with plagiocephaly due to craniosynostosis left untreated, this can result in permanent head deformity, increased cranial pressure, and seizures. More severe cases may require surgical intervention before age 1 year to correct this deformity.

Physical Therapy Management
For positional plagiocephaly, physical therapy can help you work on strengthening weak muscles in your baby’s neck and trunk, address range of motion limitation due to muscle tightness, encourage increased tummy time play when awake, and recommend positioning of toys and equipment to encourage full range of motion of neck and trunk. In a study conducted by Cummings 2011, researchers found that when both physical therapy and repositioning instruction was provided, this was far superior that repositioning instruction alone in the treatment of positional plagiocephaly.

If you notice an area of flatness on the back or side of your baby’s head, consult with your pediatrician during their next wellness visit for therapy recommendation. Schedule your free screening with Triumph Pediatric Center today!

References

1. Cummings, Carl. “Positional plagiocephaly.” Paediatrics & child health vol. 16,8 (2011): 493-6. doi:10.1093/pch/16.8.493
2. https://childrensnational.org/visit/conditions-and-treatments/genetic-disorders-and-birth-defects/plagiocephaly#tab-9
3. https://www.hopkinsmedicine.org/health/conditions-and-diseases/deformational-plagiocephaly
4. https://www.seattlechildrens.org/conditions/positional-plagiocephaly/
5. https://kidshealth.org/en/parents/positional-plagiocephaly.html