Plagiocephaly

by Dr. Gregory Gordon

pla·gi·o·ceph·a·ly (noun)
a malformation of the head marked by an oblique slant to the main axis of the skull and usually caused by closure of half of the coronal suture.

In the 1990s, the United States began the “Back to Sleep” program to reduce the risk of SIDS (Sudden Infant Death Syndrome). This program has been very effective at saving lives and reduced the incidence of SIDS. Unfortunately, we have learned that placing children on their backs can lead to positional deformities of the skull.  Estimates are that 22% of children in the United States will develop some degree of abnormal skull molding.

As a pediatrician, I have learned to look for abnormal head shape, medically referred to as plagiocephaly.  I frequently find children who have developed a symmetrical flat area in the back of their head.  This variation of plagiocephaly seems to be the most common.  These flat areas result from laying a child on firm flat surfaces too often.

Often a pulled or injured neck muscle causes plagiocephaly. This muscular injury could occur in the womb, at delivery or anytime the child’s head is not well-supported.

When an adult pulls a neck muscle, she consciously attempts to stretch it out. When babies pull a neck muscle, they choose to look the way that does not hurt. As they keep their heads turned, they begin to develop an off-center flat spot on the back of their heads. If not corrected, this will worsen and begin to effect other areas of the skull. Given time, the muscular injury will get better, but the abnormal head shape could last.

Therapy is centered around stretching out the pulled neck muscle to allow the head to rest in a more normal position. Breastfed infants are often forced to turn their heads both ways by feeding on both breasts. Formula-fed infants whose parent feed the same way are often not forced to turn their heads both ways.

Addressing the issue at home:

1~ Reverse how you feed your child. This is especially important for bottle-fed children whose parents feed the same way. Simply by switching hands, you can begin to correct the problem.

2~ In most cases, I recommend gentle stretches with every diaper change. The two preferred stretches are turning the head from side to side in a “no” pattern and from ear to shoulder. These stretches should not be forced. Stretches should be done when child is relaxed and happy.

3~ Minimize your child’s time in car seats, swings and other “containers.” When baby is in the car seat, place your child’s car seat toys toward the side that you want him to look. Next time, move the toy to the other side.

4~ When you place your son in his crib, orient him so that he is encouraged to stretch his neck. This orientation forces your baby to self-stretch if he wants to see desired objects. Place him in the crib such that when he wants to turn and look at the middle of the room, he will be stretching the damaged muscle.

5~ One of my boys had mild plagiocephaly secondary to a strained neck muscle.  We saw the most improvement by gently “bouncing” him around the house with his neck positioned carefully. When I held him I would gently turn his head and “bounce” him for comfort.

If home-stretching fails, some children will need physical therapy.

After the neck musculature improves, parents usually see improvement in the child’s head shape. But in some cases, the plagiocephaly does not improve on its own. A referral to a pediatric neurosurgeon should be made by 6 months of age if significant plagiocephaly continues.

After an evaluation to rule out other abnormalities, the neurosurgeon may recommend the child wear a corrective helmet. These helmets must be custom-designed to “round out” a child’s head shape. Corrective helmets typically cost $2,000 to $3,000 and are often not covered by insurance.  If that is the case, parents must weigh the cost of a helmet verses the likelihood of cosmetic deformity.

References

Andrea E Bialocerkowski PhD BAppSc (Physio) MAppSc (Physio), Sharon L Vladusic BPhty, Choong Wei Ng MBBS BMedSci, “Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review”, Dev Med Child Neurology, 1 AUG 2008.

Dr. Gregory Gordon

Dr. Gregory Gordon grew up in Gainesville, Florida. He attended the University of Florida for both his undergraduate and medical degrees. After he completed his pediatric residency at the University of Alabama at Birmingham, he joined Pediatric Associates of Orlando. Dr. Gordon is the proud father of seven children. He is the Vice President of “The Gift of Swimming” (a local charity that provides swim lessons to Orlando’s needy children). In early 2010, encouraged by his patients, he started gregorygordonmd.com to share his pediatric and parenting experience.