• Positional Skull Deformity

    (Flat Head Syndrome; Plagiocephaly; Brachycephaly; Scaphocephaly)

    Definition

    Flat head syndrome is the flattening of an infant’s head due to continued pressure on one spot. These changes to the skull cause the head to look distorted, but are purely cosmetic and not associated with problems of brain function or growth.
    There are 3 common types of flat head syndrome:
    • Plagiocephaly: Flattening on one side of the occipital bone (back of the head)
    • Brachycephaly: Equal flattening on both sides of the occipital bone
    • Scaphocephaly: Equal flattening of both parietal (side of the head) bones, usually in premature infants
    Infant Brain and Skull
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Infant’s skulls are softer than older children. A softer skull is a normal part of growth and development but can make the skull more vulnerable in the first few months after birth. Pressure on a softer skull can cause a change in the shape of the head. The pressure is most often caused by long periods of time with the head resting in the same position. Since young infants have little control over head movement they are more likely to spend long periods of time in the position they are placed in.
    Older infants are less vulnerable to these changes because their skulls become harder and they are better able to control their head movements.

    Risk Factors

    Factors that may increase your baby’s risk of flat head syndrome include:
    • Preference for sleeping or laying in the same position
    • Torticollis—a preference to turn the head to one side and turn the chin to the other
    • Babies who are born prematurely
    • Babies with weak muscles who may be unable to move their head around

    Symptoms

    Babies with flat head syndrome have a flattened spot on one area of the head. Plagiocephaly and brachycephaly may also result in distortions of the face on the opposite side.

    Diagnosis

    The diagnosis can be made by physical appearance and physical exam.

    Treatment

    Talk with your baby’s doctor about the best treatment plan for your baby. Options include:

    Repositioning Your Baby

    Regularly changing your baby’s position will relieve pressure on the affected area of the skull. Some steps include:
      Position your baby throughout the day so that the head rests on areas that are not flattened. You may have to reposition the head often during sleep since your baby’s head may be inclined to move toward the flattened area.
      • Babies should always be placed on their back to sleep.
      • Do not use a pillow or other device to keep your baby in one position.
    • Tummy time can also help relieve the pressure on the skull. Make sure your baby is awake and supervised during tummy time.Try moving a light, a toy, or some other visual cue around the top of the crib so the baby will move their head to focus on them.

    Physical Therapy

    Physical therapy may be used to teach you exercises you can do with your baby. The exercises will include stretching your baby’s neck muscles and decreasing the preference to rest on one side only.

    Helmet Therapy

    If your baby’s condition is severe, a custom-molded helmet or band may be advised. The device will apply pressure on a baby’s skull to promote a more rounded head shape.
    Your baby’s head shape will improve over time. Helmet therapy will only shorten the process.

    Prevention

    To help reduce your baby’s chances of getting flat head syndrome, take these steps:
    • Alternate your baby’s position until your baby is old enough to move independently
    • Supervise your baby as he or she spends 30-60 minutes a day on his or her stomach until your baby is able to roll easily and sit
    • Minimize the amount of time your baby spends in car seats and swings; pay attention to his or her head placement.

    RESOURCES

    Healthy Children—American Academy of Pediatrics http://www.healthychildren.org

    Kids Health—Nemours Foundation http://www.kidshealth.org

    CANADIAN RESOURCES

    Caring for Kids—Canadian Paediatric Society http://www.caringforkids.cps.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Flat head syndrome (positional plagiocephaly). Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/parent/growth/sleep/positional%5Fplagiocephaly.html. Updated October 2014. Accessed November 10, 2015.

    Plagiocephaly. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/health-topics/conditions/plagiocephaly. Accessed November 10, 2015.

    Plagiocephaly and brachycephaly (flat head syndrome). NHS Choices website. Available at: http://www.nhs.uk/conditions/plagiocephaly/Pages/Introduction.aspx. Updated April 29, 2014. Accessed November 10, 2015.

    Positional plagiocephaly. American Association of Neurological Surgeons website. Available at: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Positional%20Plagiocephaly.aspx. Updated September 2010. Accessed November 10, 2015.

    Positional plagiocephaly. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T905714/Positional-head-deformity. Updated October 6, 2014. Accessed November 10, 2015.

    Positional plagiocephaly. UCSF Benioff Children’s Hospital website. Available at: http://www.childrenshospitaloakland.org/main/Positional-Plagiocephaly.aspx. Accessed November 10, 2015.

    Positional plagiocephaly in children. Seattle Children’s website. Available at: http://www.seattlechildrens.org/medical-conditions/chromosomal-genetic-conditions/positional-plagiocephaly. Accessed November 10, 2015.

    van Wijk RM, van Vlimmeren LA, et al. Helmet therapy in infants with positional skull deformation: randomised controlled trial. BMJ. 2014 May 1;348.

    What is flat head syndrome (plagiocephaly or brachycephaly)? NCT website. Available at: http://www.nct.org.uk/parenting/what-flat-head-syndrome-plagiocephaly-or-brachycephaly. Accessed November 10, 2015.

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