Plagiocephaly (Flat Head Syndrome) – Reasons & Treatment

Babies are soft and vulnerable when they are born, and there is still a lot that needs to develop. One of the crucial body parts that need a lot of care is your baby’s skull. It is known for the baby’s head to become misshapen during birth because it is not fully developed yet. If this happens to your baby, do not blame yourself! This is called plagiocephaly and is quite common. Read on to find out more about this condition.

What Is Plagiocephaly?

More commonly known as Flat Head Syndrome, plagiocephaly appears as a flattened surface on the back or side of your baby’s head. It can negatively affect the alignment of the ears, jaws and eyes in severe cases. This usually disappears by the time your baby starts to sit up, at around four months of age. Babies as young as one week have been known to be affected by it too. However, it might comfort you to know that there has been no indication that plagiocephaly is responsible for causing any kind of problems to a child’s growth and development.

Types of Plagiocephaly

Plagiocephaly is the blanket term that is used to cover several different types of Flat Head Syndrome, though it really only refers to the condition where there is a flattening of the side of the head (making the head appear like a parallelogram when viewed from the top). Here are the types of Plagiocephaly:

1. Brachycephaly

In this, there is a uniform flattening that covers the entirety of the back of the baby’s head. The head is hence broader than normal. At times, the forehead of the child seems to bulge out.

2. Asymmetrical Deformational Brachycephaly (ADB)

This is kind of like a mixture between Plagiocephaly and Brachycephaly. Here, the back of the head is flattened and leads to a very wide forehead as well as an asymmetrical appearance.

3. Scaphocephaly

Here the head is long and narrow but the forehead is wide. The sides of the head can also have a flattened appearance. Scaphocephaly is most often congenital and is often seen in babies who are premature.

What Causes Flat Head Syndrome

There are many reasons why babies can develop misshapen heads, and though parents of children who develop this condition often find it easy to blame themselves, it is really not the case. Some of the reasons why Flat Head Syndrome develops in babies include:

1. Premature Birth

It is normal for babies to have soft skulls, but premature babies have even softer skulls as they are more underdeveloped than the average child. Another reason why premature babies are more prone to developing this condition is all the extra time that they have to spend in the NICU.

2. Multiple Births

There can be limited space in the womb when there is more than one baby in there at a time, and so twins and triplets have been observed to have this.

3. Womb Situation

Some babies simply become stuck in one position and develop an abnormal skull shape, while there are others who have mothers with small uteri where there is not much room to move.

4. Back Sleeping

In order to prevent Sudden Death Syndrome in babies, it is recommended that babies sleep on their backs, but the relationship between back sleeping and Flat Head Syndrome is quite well known.

5. Convenience Devices

Carriers, bouncy seats, car seats and swings all require the baby’s head to be pressed up against something surface, which puts the baby at risk of developing Flat Head Syndrome. Routine use is fine, but when the baby is left to sleep in such carriers for extended periods of time, he or she is at a higher risk of developing it.

6. Torticollis

In this condition, one of the neck muscles is either tighter or shorter, which encourages the baby to keep his or her neck in one position. Plagiocephaly and torticollis in infants go hand in hand; about 85% of babies with plagiocephaly have been observed to have torticollis as well.

Signs and Symptoms of Plagiocephaly

The signs of Flat Head Syndrome, or Plagiocephaly, will vary according to the level of severity. Here are the signs and symptoms of flat head syndrome:

• There will be flattened surfaces on the front, side or back of the baby’s head.
• A bald spot is seen in the affected area.
• The head will appear misshapen or perhaps even slanted.
• The ears will be uneven; one side either being too high up on the head or maybe one protrudes forward more than the other.

In more serious cases, your baby’s head may not grow properly. There may be some hard edges or ridges along the skull. There will also be no soft spot on your baby’s head. Finally, the facial features might be uneven, or there may even be other facial defects present.

How Is Plagiocephaly Diagnosed?

The skull of a baby is soft, and it is still developing, continuing to grow and change shape as time goes on. It will be easy for you, as parents, to identify whether or not your baby’s head is growing, and as the doctor will also measure your baby’s head during the usual check-ups, she will also be able to tell immediately if something is wrong.

There is no need for many tests to be performed to know if your baby has Flat Head Syndrome or not. If your doctor suspects anything, an X-Ray or a CT scan will be scheduled in order to look for sutures that may be fused, or if there are any ridges along the same. The doctor will be able to check for craniosynostosis too at this time (premature fusing of the bones of the skull in an infant), though in most cases it is ruled out as it is a very rare occurrence.

Treatment for Flat Head Syndrome in Infants

The doctors will decide a method of treatment depending on your baby’s age and how severe the case is. Repositional therapy is recommended for children who are young and who have mild cases. For others, cranial orthotic therapy may be required, where a helmet or a headband is prescribed for the child to wear.

1. Repositional Therapy

In this, you have to keep changing your baby’s position in order to avoid putting too much pressure on the flattened part. Some ways in which you can do this are:

• When your baby has to sit, avoid leaving her to sit in the car seat, baby carrier etc., for too long where her head will be resting in one place.
• At nap time or bedtime, keep changing the position in which you put your baby to sleep.
• While feeding, keep switching the sides that you give your baby a bottle from so that there is no pressure on the same spot each time.
• While your baby is awake, you will be asked to allow them to spend some tummy time under your careful supervision. It is important for babies to spend time on their stomachs as this helps to reduce the chances of your baby developing plagiocephaly by strengthening the muscles in the neck.
• Some physical therapy may be recommended by your doctor to make sure that your baby’s neck muscles strengthen. These must be done regularly and as gently as possible.

2. Cranial Orthotic Therapy

If all the above measures are not successful then:

• You will need to think about Cranial Orthotic Therapy in which your baby needs to wear a baby helmet or a headband for about 23 hours a day.
• These are custom made to each child and is meant to be used to correct the shape of the head.
• Treatment by this method generally lasts from two to six months, depending on how severe the case is or how early treatment is sought.

Can Plagiocephaly be Prevented

The preventive measures are pretty similar to the repositional therapy techniques. Here is how to prevent flat spots on a baby’s head:

• Keep changing the position of the baby pillow to prevent a flat head by changing the direction in which your baby lays her head.
• When your baby is awake, try giving her more activities to do when she is on her tummy. Carrying your child, cuddling and hugging your child to reduce the pressure on your baby’s head. will also work.
• Make your baby engage in different activities such as rolling, crawling, pushing, holding and grasping things.
• Do not leave them in car seats or any other kind of ‘propped’ position for too long.

Will Plagiocephaly Affect My Baby’s Brain Development?

So far, most doctors say that there is no connection between Plagiocephaly and brain damage. It does affect how the skull is shaped, and if it is accompanied by torticollis then there may be some impairment in the movement, but these can be fixed through therapy.

When to Consult a Paediatrician

You should consult your doctor if your baby’s head looks strangely shaped even after two months since birth, or if you notice that he has a strong preference for turning his head to one side all the time. This could be deformational plagiocephaly and will need to be looked at by a professional.

Your general practitioner can refer you to a paediatrician, a paediatric physiotherapist or even a plastic surgeon as per your case and needs.

Always remember that there are a lot of reasons why your baby may develop Flat Head Syndrome and that in most cases it rectifies itself as it is something that is quite common in babies and at least half of babies have this in some form or the other.

While most are certainly not so severe, there are cases in which the situation calls for some special attention. The shape of your baby’s head should become normal by two months of age, and if it is still not, you can take repositioning methods and work with your child to rectify the problem. The same techniques can more or less prevent.

In more serious cases, you will need the help of helmets or headband that are custom made to help your baby get his head back in shape. Your doctor will be able to guide you. Remember that this is something that you can fix if everyone works together.

Also Read:

Shaken Baby Syndrome in Infants
Baby Shaking Head Side to Side – Is It Normal?