Everything There’s To Know About Plagiocephaly (aka Flat Head Syndrome)

Are you concerned about the shape of your infant’s head? Do you notice flatness on one side more than the other?  Tiny Transformations can help!

Plagiocephaly sometimes known as “flat head syndrome” develops when an infant's soft skull becomes flattened, due to repeated pressure on one part of the head.  Babies’ heads are soft and pliable and even gentle forces, whether met in the womb or in baby’s daily routine, can cause misshaping. The good news is babies with plagiocephaly, if diagnosed and treated early, respond very well to conservative techniques.

Typically, plagiocephaly can be caused by a variety of different situations such as:

• Torticollis
  Congenital Muscular Torticollis (CMT) is a condition in which the neck muscles are tight on one side, causing baby’s head to tilt and/or turn to one side. Torticollis often causes the head to be held in a single position, which can lead to plagiocephaly. You can learn more about Torticollis here

• Back-Sleeping
  The relationship between back-sleeping and plagiocephaly in infants is well-documented.  There has been an increased prevalence of plagiocephaly since 1992, following the American Academy of Pediatrics’ (AAP) “Back to Sleep Campaign.”  This campaign recommended that infants be placed on their backs, to decrease the risk of sudden infant death syndrome (SIDS).   While these recommendations have been successful in reduce SIDS, there has been a significant increase in the number of babies diagnosed with plagiocephaly.   

• Carriers & Devices
  While in car seats, bouncy seats and swings, a baby’s soft head is often placed flat against a surface. Extended use of these carriers and positioning devices (often referred to as “containers”) increases the infants risk of developing plagiocephaly.

• Premature Birth
  Premature babies have especially soft skulls, making them even more susceptible to misshaping. These babies often spend extended periods of time in the Neonatal Intensive Care (NICU) unit with the head in a fixed position. 

• Womb Position/ Multiple Births
  Babies who become stuck in one position or do not have enough room to move in the womb during pregnancy are at risk of developing plagiocephaly. A breech presentation can also lead to an abnormal head shape.  Plagiocephaly is also common in cases of multiple births, where limited space in utero can lead to distortion of the head.

• Complicated birth history
  Those infants who were born with use of equipment including forceps or vacuum are at a greater risk for head deformities.

Types of head shapes vary, including:

• Plagiocephaly

  • Back of head is flat on one side and usually associated with anterior progression of the ear on the same side (resembles a parallelogram)

  • Can cause facial asymmetries specifically in the eyes, ears, cheeks, and jaw

  • Strongly associated with torticollis

• Brachycephaly

  • Flattening on the entire back of the head

  • Prominent forehead

  • Seen in those infants who spend prolonged period of time on their backs

• Scaphocephaly

  • Long and narrow head shape

  • Shape is common in babies who spend extended time in NICU or are positioned side-lying for a period of time.

How Can Physical and Occupational Therapy Help?

Early diagnosis and treatment to address skull deformities is important.   The goal of conservative treatments is to shift the infant off the flattened areas to allow the head to grow with more symmetry.  Based on the findings during the evaluation, your therapist will develop and implement an individualized plan to address your baby’s specific needs.   Your therapist will review tips and positioning strategies that can be used to promote appropriate development and improve your baby’s head shape:

      I.         Tummy Time:  The more tummy time the better!  There is no such thing as too much time spent on their tummy.  By spending more time on their stomachs, babies will also be working on their neck strength, which will help to promote age appropriate gross motor milestones.  Tummy time can be done on the floor, over a pillow or boppy, or on a parents chest to improve tolerance. 

    II.         Sidelying play:  During awake time, support your baby on their side with your hand or by placing a towel/pillow and allow for play in this position.  This position will get your child off their back and will work on strengthening muscles in this position.

  III.         Active head rotation to both left and right side:  If you notice your child has a preference to look one way, it is important to encourage active neck rotation to the more difficult side.  This can be achieved by placing toys on that side and by always approaching your child (while on the changing table, in the bath, while eating, or while sleeping) from the more difficult side.

   IV.         Avoid time spent in “containers”:  Avoid spending prolonged periods of time in a car seat, swing, stroller, or bouncer, if possible.  Try and have your baby on a floor mat or in a playard to improve active movement.

If conservative treatment techniques do not work to improve your infant’s head shape, a cranial orthosis may be recommended.  Cranial orthoses or helmets, encourage symmetrical head growth by providing contact over prominent areas and relief inside the helmet where the skull needs to grow.  Typically helmets are most effective between 4-8 months of age and are to be worn 23 hours a day. How long treatment lasts will depend upon your baby’s age and severity.  Consistent follow up is needed to make adjustments and ensure the best fit.  

If you are at all concerned about your baby’s head shape please reach out to Tiny Transformations and we would be happy to evaluate and provide recommendations!  The earlier plagiocephaly is identified and treated the better the outcomes!