Positional Plagiocephaly

What is deformational or positional plagiocephaly?

Deformational plagiocephaly is sometimes called “flat-head syndrome” and it’s a distortion of the baby’s skull. In the uterus, and for a time after birth, a child’s skull is soft. The joints between the various bony plates of the skull are not rigid and this allows the skull to change shape both during the birth process as it travels through the birth canal, and afterward as the child grows and the brain becomes larger, (primary plagiocephaly). Because the skull isn’t a rigid structure at this point in the child’s life its shape can also become distorted due to pressures caused by tensile forces in the myofascial tissues of the cervical and cranial areas (secondary plagiocephaly). 

A very rare form of plagiocephaly is called synostotic plagiocephaly or craniosynostosis, and is where the cranial sutures prematurely fuse causing the skull to become rigid and leading to a distortion of the head shape, which can appear similar in presentation to plagiocephaly.

What causes plagiocephaly?

There are several causes of deformational plagiocephaly and these include:

  • Distortion due to position in the uterus, especially if there is more than one baby.
  • Distortion in the birth canal as the head travels through it.
  • Distortion due to assisted birth with either forceps or a Ventouse, vacuum suction cap.
  • Persistently lying in one position : on back or with head turned to one side (torticollis).
  • Spending too much time in a baby capsule or cot.

What are the different types of plagiocephaly?

What does plagiocephaly mean for your child’s health?

Most cases of plagiocephaly largely resolve as the child grows and has no long-term health implications. Positional plagiocephaly does not affect the development of your baby's brain. However, if unresolved it may result in some degree of short-term developmental delay. These can include:

  • Poor co-ordination of fine motor skills.
  • Delay in developing gross motor skills such as rolling, crawling and walking.
  • If it is left untreated the plagiocephaly may change your child’s physical appearance by causing uneven growth of their face and head, ranging from uneven ear heights and shape to different size orbits (eye sockets), or a crooked smile and a head tilt.

How do you know if your child has plagiocephaly?

Most babies have some degree of misshapen head after birth, However, if you notice a severe degree of distortion, or if your baby only turns its head to one side when lying on its back, or if the distortion has not resolved itself by the time the child is two months old then it’s wise to seek the opinion of a medical professional.

What treatment options are available?

As an Advanced Paediatric Osteopath, I can assess your child for plagiocephaly (and torticollis) and advise you which treatment is most appropriate for your child’s condition. These treatments can include:

  • Gentle, hands-on manual therapy to help release tight muscles in the neck and shoulder that can limit turning of the head and contribute to a flat head.
  • Advice regarding activities that will encourage active movement of the neck, and suitable mattresses
  • Home-based exercises including increased tummy-time
  • Positional advice: such as varying the positions in which you carry or hold your baby when it is awake, and alternating your baby’s head position while it is sleeping so it faces the other side
  • Mattress recommendation: LifeNest™'s unique woven cradle contours to the shape of the baby's head allowing for a more even distribution of pressure than traditional cot mattresses. This helps reduce cranial flattening. The soft and comfortable netting also allows for free airflow, reducing sweating and overheating, and preventing rebreathing - helping reduce the risk of SIDS.
  • Approximately one in ten babies with plagiocephaly may need to be treated with helmet therapy to correct severe and persistent deformity. Dr Reena Murray works with Sydney Neurosurgeon Dr Adam Fowler and an orthotist at The Plagiocephaly Clinic at The Mater Clinic, where this treatment is provided.
  • Surgery for craniosynostosis.