Plagiocephaly: What to do if your Child has a Flat Head

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Most people would have noticed a child or baby with a flat spot on their head.

Either in the centre at the back, or off to the side causing a ‘wonky’ or ‘flat head’.  Medically known as Plagiocephaly (‘plagio’ = oblique or slanting & ‘ceph…’ = in reference to the head)

Majority of the time parents worry about the aesthetics of this issue only. Granted it’s a big concern. Often not realised is the fact that plagiocephaly can frequently coincide with a delay in a child’s development. This is when a parent often becomes more concerned.

There are two major types of Plagiocephaly;

  1. Deformational Plagiocephaly – this is the lesser of two evils. It is present in around 1/5 of two month old’s1. Simply put it is caused by external pressures, pushing or pulling the skull out of shape. This includes a large range of situations from intrauterine constraint (position in the womb), tight neck muscles, sleeping position and even car seats to name a few.
  2. Craniosynostosis – this is much more uncommon and much more serious. It is when two skull plates fuse together and prevent a baby’s skull and brain from expanding and growing symmetrically.

Deformational Plagiocephaly 

Deformational plagiocephaly in babies and toddlers causes a delay most evident in cognitive and language skills. 2-3 Without any form of intervention these delays noticed within the first 12 months are can still be present at 36 months old. 4 Meaning, within this timeframe, it is unlikely the delays will ‘catch up’ or resolve themselves. Another study found that deformational plagiocephaly was related to delays in both motor and mental function in infants, they also noted that no child with deformational plagiocephaly showed any accelerated development. 5 By school age developmental anomalies in conjunction with deformational plagiocephaly are more commonly seen in cerebral dysfunction, for example learning difficulties, which often require the parents to seek additional assistance for their child. 6-8

So does deformational plagiocephaly (flat head) cause the developmental delay or does the delayed development cause the deformational plagiocephaly? The research here is murky at best and it is hard to say 4,9. This is why assessment and treatment needs to monitor both the deformational plagiocephaly and developmental delay at the same time.

So what can be done 

A mild flat head can often be managed by a well trained and experienced children’s chiropractor. This is done with a variety of re-positioning techniques and manual therapy protocols that have the best effects when implemented in the first 12 months. The more severe deformities may need correction with cranial orthosis (helmet therapy). 6-7,10-12

Tips for home

  1. Limit the time your child spends constrained. Unless they are asleep or travelling, removed them from their car seat and off their back.
  2. Increase the time where spontaneous and unhindered movement can occur – i.e ‘Tummy-time’, or using a baby carrier
  3. Alternate sleeping and feeding positions. Ensure you breast/bottle feed from both sides equally and move the cot around the room or place your baby to sleep at alternating ends. This encourages them to look and rotate their neck to different sides.
  4. Learn different repositioning, propping techniques, massage and sensory stimulation techniques.
  5. Ensure there is no underlying cause of your child’s plagiocephaly by having them checked by a qualified practitioner.

References, and further reading

  1. Looman, Flannery. Evidence-Based Care of the Child with Deformational Plagiocephaly, Part I: Assessment and Diagnosis. Journal of Pediatric Health Care. 2012. 26;4:242-250
  2. Speltz et al. Case-control Study of Neurodevelopment in Deformational Plagiocephaly. 2010. Pediatrics. 125;3:537-542 Access Online http://pediatrics.aappublications.org/content/125/3/e537.full.pdf+html
  3. Brent et al. Development in Toddlers With and Without Deformational Plagiocephaly. 2011. Arch Pediatr Adolesc Med. 165;7:653-658 Access Online file:///C:/Documents%20and%20Settings/chiro/My%20Documents/Downloads/poa15014_653_658.pdf
  4. Collett et al.  Development at Age 36 Months in Children  with Deformational Plagiocephaly. 2013. Pediatrics. 131;1:109-115. Access Online http://pediatrics.aappublications.org/content/131/1/e109.full.pdf+html
  5. Kordestani et al. Neurodevelopmental Delays in Children with Deformational Plagiocephaly. 2006. Plastic & Reconstructic Surgery. 117:1;207-218
  6. Flannery et al. Evidence based care of the child with deformational plagiocephaly, Part II: Management. 2012. Journal of Pediatric Health Care. 26;5:320-331
  7. Miller, Clarren. Long-term Developmental Outcomes in Patients with Deformational Plagiocephaly. 2000. Pediatrics. 105;2 Access Online http://pediatrics.aappublications.org/content/105/2/e26.full.pdf+html
  8. Robert et al. Long-Term Developmental Outcomes in Patients With Deformational Plagiocephaly. 2000. Pediatrics. 105:2 Access Online http://www.pediatrics.org/cgi/content/full/105/2/e26
  9. Collett et al. Development in Toddlers With and Without Deformational Plagiocephaly. 2011.  Arch Pediatr Adolesc Med. 165;7:653-658
  10. Shweikeh et al. Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines. 2013. Neurosurg Focus. 35:4;E1
  11. Robinson, Proctor. Diagnosis and Management of Deformational Plagiocephaly – A Review. 2009. Journal of Neurosurgery: Pediatrics. 3;4:284-295
  12. 12.    Lessard et al/ Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants. Comple Ther Clin Pra