What is Plagiocephaly?

WHAT IS PLAGIOCEPHALY?

Plagiocephaly is a term used to describe the Asymmetrical shape of a baby’s skull. The condition is characterised by flattening to the right or left side of the babies head along with misalignment of the babies ears and protrusion of the left or right forehead.

Other than Plagiocephaly, babies can also develop other types of Asymmetry depending on where the flattening occurs, these are called Brachycephaly characterised by a flattening across the back of the head and Scaphocephaly characterised by a long, narrow head.

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CAUSES

Plagiocephaly is caused by pressure being placed on the baby’s skull. When a baby is little the bones in the head are made up of different plates that have not yet fused. These bones unlike adults are thin and soft so are easily moulded when constant pressure is asserted.

Plagiocephaly can form from within the uterine environment as a result of Breech positioning and multiple babies or from a long time within the birth canal (Plagiocephaly can result from the use of forceps or suction).

In addition Plagiocephaly can arise from the baby spending too much time in one position i.e. lying the baby on its back with pressure been asserted to the same place of the baby’s head. Some babies like to sleep on the back of their heads, some like to turn their heads to the side. In recent years there has been a rise in the number of cases associated with type of Plagiocephaly due to the need for babies to sleep on their back to prevent SIDS. **HOWEVER THE BENEFITS OF PREVENTING SIDS OUTWEIGH THE RISKS OF DEVELOPING PLAGIOCEPHALY SO YOU SHOULD ALWAYS PUT YOUR BABY TO SLEEP ON ITS BACK** – There are however measures you can take to minimise the risks of Plagiocephaly developing.

JUST HOW COMMON IS PLAGIOCEPHALY?

Many of you probably have never heard of Plagiocephaly yet surprisingly it is now relatively common with an estimated 1 in 4 babies having Plagiocephaly to some degree!

RISK FACTORS

There are certain factors which slightly increase the risk of your baby developing Plagiocephaly, these are:

• ·         It’s your 1^st baby
• ·         Your baby is Mal
• ·         You have a Breech Baby
• ·         You are expecting more than one baby
• ·         Your baby was Premature
• ·         Your Baby has Hip Dysplasia
• ·         Your Baby has Reflux
• ·         Your Baby has tortocollis – a tightening of the next muscles usually indicated by your baby having a preference to look to the side with difficulty turning their head the opposite way

CAN YOU SPOT THE SIGNS?

The following could be signs of your baby’s head flattening:

• head turned one way most of the time
• head tilted to one side most of the time
• flat spot on back or one side of the head
• bulging on one side of the head
• one ear more forward than the other
• asymmetry of the face

PLAGIOCEPHALY PREVENTION

There are several ways to decrease the risk of your baby developing Plagiocephaly:

EARLY RECOGNITION AND AWARENESS – if you know what Plagiocephaly is the chances are you will spot the signs early before it becomes too severe. The younger the child is the better chance of stopping the progression.

·         TUMMY TIME – Give your baby plenty of tummy time, this lifts pressure off of the affected area allowing natural correction to begin. Your baby may not like it to start with but there are ways of making it more comfortable – try leaning them over a pillow and entertain them with lots of toys. Start of small gradually increasing the time spent on the tummy and before long your baby will realise its actually quite nice to be that way up (however still place your baby to sleep on their back, this is for awake time!)

·         SLEEPING PATTERN – adjust the toys in the cot to encourage your baby to look different ways. When your baby is asleep gently manipulate the head into a new position to keep pressure off the affected area.

·         CARRIERS/WRAPS/SLINGS – Carry your baby with you, if you need to do the housework invest in a wrap. Take a baby carrier out rather than the buggy – this all relieves pressure on the skull and even increases bonding between you and your baby!

·         PHYSIOTHERAPY – Babies with stiff neck muscles (Tortocollis) may benefit from addition physiotherapy to help loosen the muscles and encourage full movement in the head. Talk to your doctor and Health visitor regarding simple exercises and stretches that you can also do at home.

·         CRANIAL OESTOPATHY – If you baby is showing symptoms of Plagiocephaly you a cranial osteopath can help manipulate the skull back in to a more natural shape by gently asserting pressure on certain parts of the skull. This does not hurt the baby at all. Although you can have this treatment at any age, the best results happen up to 4-5 months of age.

HOW IS PLAGIOCEPHALY DIAGNOSED AND TREATED?

 

If you live in the UK the answer to this question may unfortunately be not very easily. In the UK the NHS only recognise the condition as cosmetic so getting a proper diagnoses can be a long and frustrating process – which for this condition isn’t ideal as early treatment gives greater success.

If you are at all concerned over your baby’s head shape you should always talk to your Health Visitors and GP’s to ensure your baby is not suffering from a more severe condition called craniosynostosis.

If your Baby is not suffering from craniosynostosis you will more than likely hear the condition will improve as the baby grows and in a lot of cases this will be true. The less severe the Plagiocephaly the more chance your Childs head will revert back to a more natural shape if you take the prevention measures above. However the more severe the Plagiocephaly the more treatment your child is likely to need. So how do you know if your Childs Plagiocephaly is Moderate, Severe or Very Severe? Well the simple answer is you don’t! The NHS do not even measure, they go by sight which makes it extremely difficult to tell if improvement is indeed happening. Repositioning and Cranial osteopathy have the greatest impact up to 4 – 5 months of age – If after this time you feel your baby’s head is still severe they may need specialist treatment in the form of Helmets.

If you have concerns over the severity of your babies Plagiocephaly there are a number of specialist orthotic clinics across the UK that provides information and treatment. The initial appointment is often free of charge and your Baby’s head measurements will be taken and the severity of the Plagiocephaly will then be calculated and measured. Whether you decide to opt for treatment in the form of Helmets (Moulded specifically to your own babies head, sitting snugly where growth is not required and leaving space where growth is needed, resulting in a rounder head shape) and are totally a personal decision but it cost on average £2000. For those who are considering this option please visit the charity Headstart4babies who may be able to assist with Funding.

PLAGIOCEPHALY PROGNOSIS

 

Most cases will rectify itself if the Plagiocephaly isn’t too severe and you take the prevention steps above. However for the more severe cases, there has been research in other countries that support the view it is more than just cosmetic issues and the reasons why the NHS should not just regard this condition as just cosmetic. This includes:

• A high risk for learning delays and developmental delay
• Increased need for special services when the child reaches school age
• Orthodontic and TMJ issues
• Scoliosis
• Visual disturbances including visual field defects, and astigmatism
• auditory problems and infections
• Psychological/social issues

For those of you that enjoy reading scientific literature this may be of interest: Neurodevelopmental implications of 'Deformational' Plagiocephaly