How to recognise plagiocephaly or a 'flat head' in your baby and what to do about it.
Is your baby’s head looking a little pancakey?
It’s okay Mama or Papa. You’re certainly not alone.
Always place babies on their back to sleep. Plagiocephaly or not.
Almost 50% of infants have some degree of plagiocephaly today, influenced largely due to the ⚡️very important⚡️ “back to sleep” - now known as the “safe to sleep” campaign.
“In response to evidence that stomach sleeping might contribute to SIDS, the American Academy of Pediatrics (AAP) created its "Back to Sleep" campaign, which recommended that all healthy infants younger than 1 year of age be placed on their backs to sleep. Babies should be placed on their backs until 12 months of age.”
Source: www.kidshealth.org
We know that the SIDS back to sleep campaign has been hugely successful in reducing the infant mortality rate - by 50% in the US. So it’s hugely important to follow the guidelines, even if your baby has plagiocephaly. But what has followed on from the campaign is that many families are now afraid to put their babies on their tummies at all. And also, babies spend a hella-va-lotta time sleeping when they’re little ( I know it might feel like your baby doesn’t spend much time sleeping, but in comparison to us, yeah they do). Sometimes up to 20 hours over a 24 hour period when they’re teeny.
Hence the huge amount of babies out there with funny shape heads these days (to varying degrees of course). But what is plagiocephaly exactly? And what causes it?
Taking a “birds eye view” of your baby’s head will help you identify early signs (1)
What is plagiocephaly?
Plagiocephaly is a misshapen, asymmetrical or flattened head shape in a baby.
It is caused by ongoing asymmetrical external pressure on a baby’s soft and flexible skull.
It’s due to baby having a side preference (always looking to one side preferred over the other)
And it could be caused by torticollis (a tight neck)
But never fear - plagiocephaly can be treated very effectively by a Paediatric Physiotherapist if caught early. It’s never too early to seek help.
How to recognise torticollis and first signs of plagiocephaly
“I didn’t even realise” . It’s the thing that I hear the most from parents of baby’s with a flat spot. And I totally get it. My first born ended up with a flat spot. My child. A physio’s child. Had Plagiocephaly. I was so caught up in learning how to become a Mum that I didn’t even realise either.
I was mortified when I did realise. But I was kind to myself, because like every other new Mum out there I was going go through a huge life change with a pretty tricky screamy baby who didn’t feed or sleep that well, and I didn’t even think to look at the top of his head too carefully. I was too busy snorting his delicious smell up instead. Or crying into it.
So parents, if it can happen to me, it can happen to anyone…. and this is your gentle reminder to take a really good look at your baby’s noggin.
Top Tips for recognising early signs
Routinely check your babies head and neck.
Ensure they can turn their head equally both ways (after 1 month of age your baby should be able to turn their head by themselves when lying on their back). Use a rattle, light, or contrasting black and white image to get their attention.
Take a “birds eye” view photo of the top of their head to check for asymmetry (getting someone else to do this whilst they are feeding might help)
Check their ears in the photo - is one further in front than the other?
Check the back of head in the photo- is one side flatter?
Now check the forehead - is one side bulging out more than the other?
Look back at old photos of them from ‘front on’ and see if they are looking or tilting their neck in the same way in every photo. This is a big sign that your baby might have a torticollis (tight neck muscles).
If you notice any of these signs, please book in to see your local paediatric physio. The earlier you seek treatment, the easier it will be to fix. And don’t hesitate. Don’t just ‘wait and see’ like so many doctors will tell you. It’s an easy fix if picked up early, and if you have the assessment and nothing needs to be done, then at least you can have peace of mind.
Side-lying is a wonderful developmental position that is an alternative to tummy time and helps remould the skull if plagiocephaly is already present.
Prevention is better than cure
We all know this.
So what are the things you can do from day 1 of bringing your new little bundle home to help prevent any head flattening from occurring?
Know the signs (see above)
Talk to and move with your baby regularly, placing them in a variety of positions throughout the day
Regular bursts of tummy time throughout the day (starting with skin to skin, on your chest). Need more help with tummy time? I gotchu. Check out my My Strong Little Body here.
Try ‘side-lie’ as an alternative to tummy time or ‘back time’ when on the floor.
Avoid excessive use of “containers” such as bouncers, swings and car capsules. Aim for 30 mins total a day (not including car rides). Learn more about “container syndrome” here.
Alternate which shoulder or arm you are carrying your baby on, and alternate which side you are bottle feeding on.
Place a peg on the side of the basinet that your new baby is facing when they go to sleep. Ensure you change it (and the way baby’s head is turning) each time you put them to sleep. This is much harder as baby gets older, so start early!
If baby sucks their fingers on one side, try covering that hand with a baby mitten/sock to encourage the other side, or perhaps try and introduce a dummy.
Physiotherapy for babies with plagiocephaly
Treating plagiocephaly in the early stages is simple. But it requires persistence and consistency from the family for it to be effective. You will essentially be treating your baby yourself at home. Your physio will be your friendly coach along the way.
Your physio will assess your baby’s head shape and may use a variety of ways to measure the severity of the plagiocephaly. They will also assess if your baby’s neck is tight, and see if there is stiffness in the trunk as well (it is quite common with babies with a side preference to have compensatory changes in the trunk). Your physio will also assess how your baby is moving generally, how they cope with different positions on the floor, and they will then show you a variety of ways to position and carry your baby to help remould their head shape, stretch and strengthen their neck muscles, and different ways to support your baby’s general development.
It is quite common for babies with plagiocephaly to have a mild developmental delay. The plagiocephaly itself isn’t the cause of the delay, but more a marker for your therapist to assess and identify those bubs with delays.
Your role is to ensure all these individualised strategies and exercises and play positions are implemented at home on a daily basis to ensure changes occur.
Your physio will want to follow up with baby within the first week or two after the initial assessment, and then if happy with their progress, will extend out review periods until they are happy baby’s head shape, neck and trunk movement and general development is back on track.
Helmet therapy can be effective in treating severe cases of plagiocephaly (4)
Helmet Therapy for Plagiocephaly
There is conflicting advice in the literature about whether helmet treatment for plagiocephaly is effective. A major 2014 study (2) discouraged helmet use after concluding that there was equal effectiveness between helmet therapy and ‘natural course of treatment’. Another huge 2015 study (3) concluded 77% of infants gained full correction with conservative treatment (physiotherapy alone) but 96.1% of infants who received helmets after failed conservative therapy gained full correction.
The general consensus from the American Academy of Paediatrics and The Australian Physiotherapy Association is that “helmets are most effective in cases of severe plagiocephaly” . For mild to moderate cases and for babies under 6 months of age , conservative treatment from a paediatric physiotherapist usually achieves desired outcomes.
Long term effects if left untreated
Positional plagiocephaly will not effect the growth of the brain.
There are other (rare) skull conditions (craniosynostosis being the main one) that will affect growth of the brain and may require surgery. See ‘scaphocephaly’ below, a sub-type of craniosynostosis. This is an important reason to get any skull asymmetries checked by a health professional as soon as you notice them.
Infants with plagiocephaly do show an elevated risk of developmental delay
Plagiocephaly may change the child’s physical appearance by causing uneven growth of the face and head. (Think sunglasses, glasses and hats/helmets as they get older, as well as shaved/bald heads in boys!)
These are all very good reasons to ensure you get in early and get your little one’s head shape looked at to prevent long term issues from occurring. We all want the best for our babies, and plagiocephaly is a very common but very easily fixed condition if treatment is sought early.
There are several different types of infant skull deformities, Plagiocephaly being the most common. All need to be assessed by a health professional. (5)
Key Points
Plagiocephaly is the most common infant skull deformity, present in varying degrees in 50% of infants.
It is a misshapen, asymmetrical or flattened head shape in a baby,
It is always caused by a side preference, which can sometimes be due to a torticollis or a ‘tight neck’ in babies.
Always seek assistance and support if you notice any asymmetries or ‘flat spots’ on your baby’s head that aren’t evening out after 6 weeks of age (it is normal to have a misshapen head in the first few weeks after birth).
6 weeks is an ideal age for initial assessment (don’t just ‘wait and see’) and if you seek treatment early, prognosis is excellent.
Helmet therapy can be avoided with consistent early positioning strategies and treatment to the neck but may be necessary in severe cases when baby is older than 6 months.
Want to avoid plagiocephaly? Definitely buy the book.
If you would like an entire program of purposeful play ideas to help nurture your baby’s development from birth to walking (including whole chapters on supporting tummy time, crawling and beyond) check out my book My Strong little body.
It’s the book parents were asking for, full of guided reassurance and support from a paediatric physiotherapist.
And if implemented from the start, is really going to help you avoid the old flat head.
Love Alana xx
P.s did you know I also offer tele-health services? if you have concerns about your baby’s head shape I can easily help you with assessment and treatment strategies for your babe over a video call, all from the comfort of home. It’s easy peasy.
References:
Image sourced from www.physio-pedia.com
Helmet therapy in infants with positional skull deformation: randomised control trial. BMJ 2014; 348: g2741 doi: 10.1136/bmj.g2741
Effectiveness for conservative therapy and helmet therapy for positional cranial deformation. Plastic and Reconstructive Surgery. March 2015; doi: 10.1097/PRS.0000000000000955
Image sourced from www.healthychildren.org
Image sourced from www.cranialtech.com