PLAGIO-WHAT? PREVENTING & ADRESSING FLAT HEADS

What is deformational plagiocephaly and how do you prevent it? Long definition aside, plagiocephaly is an asymmetrical head flattening in infants that is caused by repetitive positioning. Babies’ heads are soft and mobile, this helps them through the birth canal, but this makes how you position your baby after they are born very important. Sometimes flattening starts in utero, especially with multiples, sometimes there is an underlying issue like torticollis,and sometime an infant’s biased positioning during sleep or in the NICU creates a head shape that is not re-rounded during waking playtime. The first 6 weeks are vital for remolding any cranial asymmetry, and I am here to help!

As a practicing pediatric physical therapist, I have been treating and trying to prevent flat heads on babies for over 20 years. Yet, these sweet little flat heads just keep on coming and although I appreciate the job security I would much rather prevent plagiocephaly.

Three Major Risk Factors…That Lead to Head Flattening in Infants Include:

1.      Too much time in supine (on their back).

2.      Too much time in supportive equipment.

3.      Too much repetitive positioning.

How your baby nestles into your womb impacts their head shape, but there is no point in stressing about something you have no control over, just be mindful after birth, especially if your baby’s head does not start out perfectly round.

How Do I Prevent a Flat Head?

THE TOP 6 WAYS TO PREVENT A FLAT HEAD:

1.      TUMMY TIME: Back to sleep is important to prevent SIDS, but supervised waking tummy is just an important for waking play! Tummy time helps prevent flattening, encourages neck length and strength, and enhances motor and visual development.

2.      Switch Sides: alternate the side you carry, feed, change, nap & bathe your baby. A baby’s vision runs the show and if they are always looking to the same side, it will impact their neck muscle development and also their head shape.

3.      Skip the Containers: equipment is convenient, but prolonged time in car seats, strollers, infant seats & swings forces little necks to hold up heavy heads for too long and too early in development. Young babies are just not strong enough to work against gravity for that long. This will often create a bias and head flattening and if one already exists it will make it worse, not to mention too much time in equipment is also likely to stunt baby’s motor development.

4.      Try Side-lying Play: playing in side-lying is a great way for young babies to get a break from tummy time without going to their backs. Side-lying also encourages using two hands to play and is a soothing position for their neurological system.

5.      Stretch It Out: If your baby has torticollis, talk to a physical therapist about how to stretch your baby’s neck muscles, especially the sternocleidomastoid muscle (SCM). The SCM is a large neck muscle that side-bend the neck to the side and rotates or turn the head to the opposite side. Talk to your pediatrician or PT about the proper way to stretch.

6.      Get Early Intervention Physical Therapy: if your baby was premature or was in the NICU, if your baby has torticollis or other conditions of the head, neck, spine or hips get PT as soon as possible. The earlier the better, because a lot of motor skills development occurs in the first 18 month of life!

Oh No! How Do I Correct My Baby’s Flat Head?

• Good news, babies’ heads are soft & mobile. What is flat can be round once again. If your baby is under 6 weeks the above-mentioned techniques are often enough to round everything back out. Even if your baby is over 6 weeks these daily techniques will help make things better.

• Cranial Remolding Orthosis (CRO): talk to your pediatrician about a CRO aka helmet molding therapy if your baby’s head shape is moderate to severe and they are >/3 months old. The best time to use a CRO is between 4–6-month-old, however they can be used up to 18 months with less impressive outcomes. CRO’s are worn 23 hours a day for 3-6 months.

What is the Big Deal? Won’t They Just Grow Out of It?

• No, they will not just grow out of it, because 3 out of 4 of your baby’s soft spots, or fontanelles, fuse by 6-18 months of age, and cranial bones begin to fuse at 2 years. Once bones fuse, changing a head’s shape becomes much more complicated.

What are the 10 Potential Long-Term Impacts of a Flat Head?

1.    Vision changes

2.    Motor delays

3.    Scoliosis, especially when associated with torticollis

4.    TMJ alignment issues & pain

5.    Language delays & disorders

6.    Self-esteem & social skill issues

7.    Asymmetrical faces

8.   Learning differences

9.   Sensorimotor & perceptual differences

10.  Neck pain & headaches

The easiest way to address a flat head is to prevent it! If your baby has plagiocephaly or another cranial deformity there is help, but the faster you address the issue the better. Communicate with your pediatrician and start the six easy prevention tips above as soon as possible. Even if your baby does not have flattening, the prevention techniques will not only prevent deformity, but they will also enhance your baby’s development. Remember the first 6 weeks is a critical window to begin reshaping.

LUCK, LOVE & LIGHT,

XO Rachel

Final Note: There are other types of cranial deformities that are addressed in similar ways, such as brachycephaly (a symmetrical back flattening) or scaphocephaly aka dolichocephaly (elongated sides often seen in NICU), and a rare condition, called craniosynostosis, which is a premature fusion of a baby’s skull bones that requires surgery. If you have concerns about any of these conditions, talk to your pediatrician and ask for a referral for pediatric physical therapy as soon as possible.