Plagiocephaly is a condition in which the head of an infant becomes misshapen. This usually occurs on one side of the back of the head (posterior plagiocephaly). It is easiest to see the flattening by looking down on your child’s head. In addition to a flat head, the child may also have ears that do not line up. This is the result of asymmetric muscle stress on the lower portion of the skull called sternomastoid imbalance. A condition called torticollis, which is a deformity of the same neck muscle called the sternocleidomastoid muscle, also creates this abnormal stress on the lower portion of the skull. This may result in ear asymmetry best seen from above when looking down on the head.
Although rarely associated with craniosynostosis, or a premature closing of the lambdoid sutures of the skull, plagiocephaly is most commonly caused by the position in which the baby spends most of his time. Recently, the American Academy of Pediatrics' recommendation that all newborns and infants sleep on their backs has probably lead to a rise in cases. However, this “The Back-to-Sleep Program” has lead to a large decrease in the number of children that die from Sudden Infant Death Syndrome (SIDS), so it is recommended that parents continue to place their infants to sleep on their backs, but it is best to vary the sleeping position to prevent flattening.
It is important that your child with a flat head be examined by his pediatrician to make sure that he doesn’t have craniosynostosis, a rare but more serious condition that usually requires surgery to correct. Your doctor can usually tell by examining your child if the flat head is caused by positional plagiocephaly or by closure of a suture. Some clues on examination that would favor a diagnosis of a positional deformity include that your child’s ear on that side of his head will be displaced away from the area of flattening. Children with posterior flattening caused by craniosynostosis will have the ear displaced toward the area of flattening. Also, with positional flattening, the forehead will be prominent or have bossing (meaning it will be bulging outwards) on the same side of the skull that is flattened in the back. If the diagnosis is uncertain, then your doctor may order skull x-rays or a CT scan or MRI to check and see if the sutures are still open.
Children with positional plagiocephaly are usually first treated by keeping them from lying on the flattened side of their head. Sometimes moving the child's crib so that it is facing another direction, or moving his toys or mobile will encourage him to turn his head. You should also try and keep him on his stomach for ‘tummy time’ during the day when he is supervised. This is called a repositioning program.
Mild deformities will usually correct on their own with these measures. If there is no improvement in a few months, then children with positional plagiocephaly may need treatment with a molding helmet or head band, such as the Dynamic Orthotic Cranioplasty Band (DOC Band®) that can help to reshape the head. These devices are worn for most of the day to mold the skull’s shape back to normal. The DOC Band® and molding helmets work best if used during your child’s first year of life.
Some children with congenital torticollis, a condition in which the muscles of one side of the neck are tight and keep the head turned to that side, are prone to get a flat head. In addition to the treatments described above, they may also benefit from physical therapy. Premature babies are also more prone to getting a flat head from positional molding of their skull.
It is important to remember that having a flat head caused by a positional deformity is a cosmetic problem and the brain continues to grow normally. Your child will not have any disabilities from this condition and if treatment is begun early, usually before six months of age, the results will be very good, with a normal or near-normal shape. Dr. Chariker has over 10 years of experience treating children with this deformity.