Positional Plagiocephaly
- What is positional plagiocephaly?
- How much experience do you have treating positional plagiocephaly?
- Who gets positional plagiocephaly?
- What does a baby with positional plagiocephaly look like?
- How is positional plagiocephaly treated?
What is positional plagiocephaly?
Top of haad of child with positional plagiocephaly (drawn by Huang MHS)
Positional or deformational plagiocephaly refers to an asymmetric or lopsided head shape typically with flattening in one area caused by an external force or pressure.
The term comes from the Greek plagio (oblique) and cephale (head). Positional plagiocephaly is caused by pressure on the bones of the skull either before or after birth.
It is different from synostotic plagiocephaly, which is caused by early closure of the sutures in the skull and requires surgery.
How much experience do you have treating positional plagiocephaly?
Our Craniofacial Center has a special clinic devoted to evaluating and treating positional plagiocephaly. We evaluate and treat more than 500 children per year for this condition.
Who gets positional plagiocephaly?
Plagiocephaly is caused by pressure on the bones of the skull before or after birth produced by such factors as a constricted position in the womb or by a baby's positional preference (how they like to lie) in the first several months of life.
Several risk factors are linked with positional plagiocephaly.
Infants with torticollis (a limited range of motion in the neck due to muscle tightness) have a strong preference to look in one direction and are at increased risk for developing plagiocephaly, since they always rest on the same spot on the back of their head.
Premature infants are also at increased risk because their skull bones are soft and they have reduced spontaneous head movement.
In very premature babies this can result in dolichocephaly of prematurity, a long (dolichos) and narrow head (cephale).
Children from multiple pregnancies (twins, triplets, etc.) and babies born to mothers with unusually shaped wombs or uterine fibroids (benign tumors made of fibrous and muscular tissue) have an increased risk of positional plagiocephaly because they are often crowded in the womb.
Children with multiple medical problems or delayed development may have a hard time changing positions and are at increased risk for developing the condition.
What does a baby with positional plagiocephaly look like?
A baby with positional plagiocephaly has flatness on the back of the skull. This is usually asymmetric because the baby likes to rest on one side more than another. Or, it can be symmetric if the baby always lies on the middle of the back of the head.
Positional plagiocephaly includes many variations of asymmetric skulls. It ranges from from mild and not very noticeable to severe and very apparent.
Sometimes the skull adapts to the pressure to produce asymmetry of the forehead. And, sometimes only the back of the head is involved.
Our team is experienced in looking for the clinical signs that distinguish positional plagiocephaly from craniosynostosis. Although these two conditions can look similar, they need very different kinds of treatment.
How is positional plagiocephaly treated?
The first treatment recommended for a child less than 6 months old is frequent repositioning of the baby's head, keeping them off the flat portion of their head as much as possible. "Tummy time," or placing a baby on their stomach when awake should be increased as much as possible.
The use of infant carriers should be limited; baby front- and backpacks should be used instead.
If your baby has torticollis (a limited range of motion in the neck due to muscle tightness), exercises or a referral to a physical therapist to increase the baby's ability to move their head in all directions will be recommended.
If repositioning does not work, treatment of moderate and severe positional plagiocephaly may include the use of a helmet.
Helmets take advantage of a baby's rapid head growth to improve the shape of the skull. Helmet use is usually started after 6 months of age, and the baby wears the helmet about 23.5 hours a day.
The treatment time varies based on the severity of the plagiocephaly and the age of the child.