cranial_remolding_plagio_photoFlat Head Syndrome or plagiocephaly is the distortion and flattening of one side of the skull, leading to an asymmetrical skull shape.

A continual misshapen head or plagiocephaly is not just a cosmetic issue 5. There are many related conditions in the research for plagiocephaly, including:

  • Developmental delays in movement and motor coordination 6-8
  • Developmental delays in language and cognitive skills 9-11
  • Hearing disabilities 12
  • Visual disabilities 5
  • Middle ear infections 13
  • Poor self-esteem 14

Plagiocephaly compromises brain function, leading to specific or general alterations in nervous system function from abnormal tone to cognition 15. Overall there is an under-functioning of the central nervous system and therefore decreased performance throughout the body.

With any of these head shape deformities there is often also a facial asymmetry. You may notice things such as; difference in eye height and shape, difference in ear position, difference in fullness of cheeks and lips, difference in the shape of the corner of the mouth and nose,  a prominence of the forehead. Your baby may also prefer to lay in one direction or you may notice that they do not look both ways evenly and there is a restriction or hesitancy when moving their neck.

In the newborn child, skull shape is highly variable. Different causes such as: prematurity, intrauterine constraint, the natural birth process, assisted delivery with forceps or suction can all lead to a wonky head shape. Due to the plasticity of the newborns skull this appearance of a flat head will generally correct itself during the first few weeks of life. In the older baby different factors, for example: torticollis (neck muscle imbalances), positioning preferences, lack of tummy time and infant carriers, can lead to an asymmetrical head shape.

In the 80s, flat head or plagiocephaly only affected approximately 1% of babies within the first 12 months 1, although since the SIDS Back-to-Sleep campaign the prevalence of plagiocephaly has increased 2-4. This has been both due to the continual external pressure moulding the back of the skull and due to the hesitancy of tummy time. Putting your baby to sleep on their back is important, as is the use of different techniques (mentioned below) to allow for symmetrical skull growth and cranial bone movement.

What can you do to minimise Flat Head Syndrome?

Early recognition and diagnosis is the key to effective and positive change! If a flat head is noticed in the first two to three months and intervention is initiated, there is a good chance of improving the baby’s head shape. After six to twelve months of age, change becomes harder, although not impossible.

Although plagiocephaly is the most common syndrome among newborns, it is important to have it checked by a professional. There are cases of skull deformity caused by craniosyntosis which may need surgical correction. This is a fusion of the skull bones and cannot be corrected by passive intervention.

Once you have been given the all clear that there is no underlying or hidden cause;

  1. Reducing positional preference and counter positioning

By taking the pressure off the flat spot, you can allow that area to round out, grow and move without restriction. This can take some creativity and attentiveness on behalf of the parents, using pillows or rolled towels to stop your baby from rolling to the preferred side or via continually monitoring and changing the resting head position.

Change the crib position around the room so they have to turn their head to look out the window or door or to a mirror. Change the position your baby sleeps in each night to encourage them not to develop a preferred side. Place crib safe toys in such a way that your baby is encouraged to turn his head away from the flattened side.

This works best for a baby less than 3months old, as the skull is still soft and your baby is likely to remain in one position longer. This can take 2-3 months to notice an improvement.

  1. Neck range of motion, stretching and strengthening exercises

One of the biggest factors in positional plagiocephaly is the preference of the baby to look to one side. Encouraging your baby with colourful toys, lights and noises to look equally from side to side, until they are happy to be laying and looking both directions. With older children when feeding in the highchair, feed from the less preferred side. Not only does this ensure equal head shape and muscular development on both sides, it also ensures equal stimulation to both visual fields and both ears. It is very important for neurological development that equal sensory information is gained from both sides of the body.

  1. Tummy time and stimulating muscle development

Tummy time and upright play facilitates neck muscle development and control, which assists in normal head growth. Staying away from hard case carriers which put pressure on the back of the head is best, as babies are already in this position to travel in the car and sleep. Carrying your baby in a sling or baby carrier on your front is best for stimulating their senses, developing neck control and taking pressure off the head.

  1. Educate yourself

Learn about the causes of positional plagiocephaly, counter positioning, handling and exercises that can assist in stimulating normal growth and development.

How can Chiropractic help Flat Head Syndrome?

The window for correcting plagiocephaly is short. As your baby grows the different skull plates come together and start to fuse. At 1-3 months the posterior fontanel closes, the sphenoidal and mastoid fontanels (side of skull) close around 6 months and lastly the anterior fontanel closes around 12-18 months.

One study compared a cohort of babies all with deformational plagiocephaly, from the age of seven weeks with no hidden cause. One group used standard positioning techniques and tummy time to treat the plagiocephaly and had a 7% decrease in the plagiocephaly measure by 6 months of age. The other group employed the assistance of manual therapy as well as positioning techniques and tummy time and had a 23% decrease in the plagiocephaly measure by 6 months of age. By 12 months of age this measure was still 7% change for the first group and a total 30% change for the intervention group.16

It is important to get help from manual therapy as early as possible to assist in treatment of asymmetrical neck muscles, torticollis and the associated plagiocephaly. We use gentle pressure and safe techniques to encourage proper and full cervical motion, cranial motion and muscular control. We can also help you with any questions you have on positioning, play time and other methods of decreasing plagiocephaly at home.

The aim of care is not only aesthetics but also to restore full range of motion, allowing full visual and auditory stimulation. We aim to maintain the motion of the cranial bones to that as the brain grows, the skull is symmetrical as is neurological function. We want your child to reach their full potential, not to be held back by delayed milestones and development.

Remember the younger the age of the child when starting care the more likely complete resolution can be achieved.

For more information or to make an appointment please call or email Better Health  ph: 9518 0722 or email: reception@betterhealthpractice.com.au

REFERENCES

  1. Bruteneau R, MullikenJ.1992. Frontal plagiocephaly: synostotic, compensational or deformational. Plast Reconst Surg. 89:21-31
  2. Bronfin DR. 2001. Misshapen Heads in Babies: Position or Pathology?The Ochsner Journal 3:4;191-199
  3. Persing J, James H, Swanson J, Kattwinkel J. 2003. Prevention and management of positional skull deformities in infants. Pediatrics. 112:199-202
  4. Mildred J, Beard K, Dallwitz A, Unwin J. 1995. Play position influenced by knowledge of SIDS sleep position reccomendations. J Pediatr Child Health. 31:499-502
  5. Balan et al. 2002. Auditory ERPs reveal brain dysfunction in infants with plagiocephaly. J Craniofac Surg. 13:520–525
  6. Ohman et al. 2009. Are infants with torticollis at risk of a delay in early motor milestones compared with a control group of healthy infants? Dev Med Child Neurol. 51:7;545–550 doi: 10.1111/j.1469-8749.2008.03195.x
  7. Hutchison BL, Stewart AW, Mitchell EA. 2011. Deformational plagiocephaly: a follow-up of head shape, parental concern and neurodevelopment at ages 3 and 4 years. Arch Dis Child. 96:85-90 doi: 10.1136/adc.2010.190934
  8. Speltz ML, et al. 2010. Case-Control Study of Neurodevelopment in Deformational Plagiocephaly. Pediatrics. 125:3; 537–542. doi:10.1542/peds.2009-005
  9. Brent R et al. 2013. Development at Age 36 Months in Children With Deformational Plagiocephaly. Pediatrics. 131:1 doi: 10.1542/peds.2012-1779
  10. Kordestani et al. 2006. Neurodevelopmental delays in children with deformational plagiocephaly. Plast Reconstr Surg. 117:1;207-218.
  11. Hutchison BL et al. 2004. Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. Pediatrics.114:970–980
  12. Siatkoski et al. 2005. Visual field defects in deformational posterior plagiocephaly. J AAPOS. 9:3;274-8
  13. Puzycki et al. 2009. Incidence of otitis media in children with deformational plagiocephaly. J Craniofac Surg. 20(5):1407-11. doi: 10.1097/SCS.0b013e3181aee369
  14. St John D, Mulliken JB, Kaban LB, et al. Anthropometric analysis of mandibular asymmetry in infants with deformational posterior plagiocephaly. J Oral Maxillofac Surg.2002;60:873–877
  15. Fowler et al. 2008. Neurologic findings in infants with deformational plagiocephaly. Child Neurol. 23:7;742-747
  16. Vargish L, Mendoza MD, Ewigman B, Hickner J. 2009. Use physical therapy to head off this deformity in infants. J Fam Pract. 58(8): E1–E3.