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WHAT TO LOOK FOR?

WHAT TO LOOK FOR?

What is plagiocephaly?

The term plagiocephaly is also known as “infant flat head syndrome”.
It is generally used to describe 3 types of positional head shape asymmetries that persist past the age of 6 weeks:

Scaphocelpaly

  • Head is longer and narrower than normal.
  • Forehead and back of head are often square.
  • Common in premature babies who have spent time in intensive care unit.

Plagiocephaly

  • Forehead bulging opposite to the flattening on back of head.
  • Ear shifting on the same side as the back of flattening.
  • Head resembles a parallelogram.
  • May be accompanied by torticollis.

Brachycephaly

  • Header is abnormally wide and tall.
  • Tips of ears protrude.
  • Face appears small compared to size of head.
  • Back of head is flat instead of rounded.

These asymmetries are caused by prolonged external pressure to the infant head. This can happen during birth, or can be caused by more subtle things like excessive time in strollers, swings, and car seats.

Deformational Plagiocephaly - the most common type of 'Infant flat head syndrome'

  • The most common type of skull deformity in infants
  • Normally noticed by caregivers at about six to 10 weeks of age
  • Characterised by an asymmetrical skull shape
  • Unilateral occipital flattening
  • Ear is positioned more anterior on the side of the occipital flattening
  • Forehead may be asymmetrical and is positioned more anterior on the side of the occipital flattening
  • Facial asymmetry may be present
  • May be accompanied by torticollis, limited neck range of motion, weakness and preferential head positioning

What are the main causes of Plagiocephaly?

Sleeping Position

The push to put babies to sleep on their back to reduce the risk of sudden infant death syndrome (SIDS) has been associated with a decrease in the incidence of SIDS but has led to an increase in the number of babies living with head shape abnormalities. Long hours in the supine position causes prolonged external pressure to an infants head.

Torticollis

Congenital muscular torticollis: This is a deformity resulting from shortening/fibrosis of the sternocleidomastoid muscle (SCM) and is associated with plagiocephaly in almost 90% of infants. Because of this shortening, the infant maintains support of the head on only one side, tilting the head toward the side of the affected muscle and turning the chin to the opposite side.

Multiple fetuses

Multiple fetuses is  related to a higher incidence of risk factors, primarily due to the fact that the “crowded” uterus means an intrauterine constraint, a factor related to deformities present at birth. It is believed that when the baby is positioned at a lower position in the uterus, there seems to be a higher risk of developing an asymmetrical skull. As the baby needs to support more weight, the mobility and capacity to change position can adversely predispose to congenital torticollis.

Lifestyle

Changes in our current lifestyle may also have contributed to the factors of postnatal deformational or positional plagiocephaly. The use of firm mattresses, frequent use of seats (in the car and for recreation, also known as babybouncers), and swings often cause the baby to stay for long periods in the supine position. The extensive use of the seat accessories would determine a greater potential to deform the skull.

Other contributing risk factors for head deformation

  • Prolonged exposure to the supine position
  • Lack of time on the tummy when the baby is awake
  • Congenital muscular torticollis, neck weakness or restricted neck range of motion
  • Males more frequently develop deformational plagiocephaly at a rate of 2:1
  • Slower motor development particularly in gross motor skills
  • Breech or transverse presentation
  • Multiple birth infants
  • Visual field deficits
  • Bony abnormality in the cervical spine

Why are the skulls of infants subject to deformation?

  • The plasticity of the newborn’s skull makes it susceptible to external pressures in the womb, during the birth process and after birth
  • The immobility of newborns and any positional neck preference can predispose infants to extrinsic skull deformities
  • Intrinsic abnormalities can be caused by craniosynostosis or through genetic transmission
  • Deformational forces most frequently affect the occiput, although the frontal bones and the face may be affected in severe cases
  • About 24%* of babies have some type of noticeable skull deformity at birth, reducing to about 20%† by four months of age
  • The abnormal shape may persist or occur if the baby spends most of the day on the back against the hard surface of infant carriers and holding devices

Severity scale - How to measure head shape and what to look for

Severity Scalexxxhdpi

How can we help?

We can provide information about the causes, signs and treatment strategies for managing head shape deformities in infants. This includes educating parents on methods of proactively decreasing the likelihood of the development of occipital flattening, initiating appropriate management and making referrals when necessary.

Treatment interventions include repositioning, a developmental home program, paediatric physiotherapy for patients with torticollis and the use of a cranial remolding orthosis to improve symmetry and normal proportion.

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