What is Plagiocephaly?
Plagiocephaly is a condition which is characterised by an asymmetric head shape deformity which occurs in early infancy and can continue throughout life. The word plagiocephaly literally translates as “oblique head”, derived from the Greek meaning of plagio “oblique” and cephale “head”. So, plagiocephaly is a deformation of the head marked by an oblique slant to the skull surface which in severe cases can also result in facial, cheek, jaw and ear asymmetry.
There are a number of more specific terms to define plagiocephaly types, including Positional Plagiocephaly (PP) and Deformational Plagiocephaly (DP) however they both mean the same thing. The skull is made up of several ‘plates’ of bone which in infancy are separate, connected by flexible ligaments known as sutures. These sutures are there to allow normal birth and to allow skull to develop as the infant brain grows. They retain some flexibility throughout childhood and as we get older, the bones fuse together and create a permanent skull shape that cannot change. However, a skull in infancy is soft enough to be moulded into deformation from external pressure. Often, a baby may display birth moulding (in severe cases known as a ‘caput’ head shape asymmetry) immediately after birth due to pressure from the uterus and birth canal, this usually corrects itself in the first few days of life. However after the baby is born, this same flexibility may result in a more lasting re-mould of your baby’s skull if your baby is left in the same position for a prolonged period of time.
Since the launch of the “Back to Sleep” campaign in 1994 it has been noticed that more infants are developing a plagiocephaly. The back to sleep initiative was developed by the American Association of Pediatrics in an effort to reduce Sudden Infant Death Syndrome (SIDS). The campaign urged parents to place babies on their back whilst they slept and has been hugely successful in reducing the incidence of sudden infant death by over 60% with many thousands of infants being saved. An unintended consequence of the guidelines has been that there is an increase in positional plagiocephaly as the back of the skull can, in approximately 5% of infants, begin to flatten when babies slept exclusively on their back. If a baby is not repositioned during the night or they do not naturally change their sleeping position, the skull shape begins to change and become asymmetric due to an application of continual pressure. We always recommend that parents continue to place their babies on the back to sleep and to reposition the head so that it does not continue to rest in one position continually. Our Repositioning Guide details all the positions that we recommend.
Noticing the indicators of plagiocephaly early on ensures your baby can benefit from more successful treatment. The key things to look out for are as follows:
• Flattening on either side of the head
• Flattening at the back of the head
• Uneven position of the ears
• The eyes differ in size and position (one eye appears lower/smaller than the other)
There are many pillows, cushions and mattresses on the market which are designed to minimise the development of a flattening and many parents use them. To prevent the risk of suffocation, the advice is that parents should only have the baby in the cot and parents should weigh the risk of a flattening against this advice. Once a baby starts to roll onto its side or to be able to wriggle and move away from the pillow, usually at 3 to 5 months of age, they become less effective and if there is a flattening, this option will no longer be of any use.
If a baby does develop the condition, Plagiocephaly Treatment options vary, dependent on the severity of each case. More severe cases of plagiocephaly may warrant the most common treatment, helmet therapy which gently allows the head shape to grow back towards normality. Plagiocephaly helmets are made from a hard outer shell with a soft and comfortable foam lining. The natural growth of head shape is encouraged by the protective helmet, defending against external pressures. As the skull continues to grow, helmet adjustments are made to accommodate the changing head shape. To put it simply, the helmet provides a protective space for the head to form its natural shape. The average length of treatment can range from three to six months depending on the baby’s age and the severity of each individual case.