Plagiocephaly Procedure Information

Plagiocephaly Procedure Information

Diagnosis and Treatment

Most often doctors can make the diagnosis of positional plagiocephaly simply by examining the child’s head, without lab tests or x-rays. Regular repositioning of the child's head during sleep is the most common treatment for positional plagiocephaly and may successfully reshape the child's growing skull. Note that true craniosynostosis typically worsens over time.

If there is still some doubt, x-rays or a CT scan of the head will show the doctor if the skull sutures are open or fused. If they are open, the doctor will probably confirm the positional plagiocephaly diagnosis and rule out craniosynostosis. Note that there are characteristic signs detectable on examination that are usually obvious to an experienced practitioner. Therefore x-rays or CT scans are not required in every child.

Treatment for the flattened head, if caused by sleeping position, is usually simple and painless for your child. Your child's doctor will probably recommend alternating both your child's direction in the crib (one night with his head toward the top of the crib, one night toward the bottom) and his head position during sleep (one night with the left side of his head touching the mattress, one night with the right).

Even though your child will probably move his head around throughout the night, alternating sides is still beneficial. There are wedge pillows used to keep babies lying on one side or the other, but Dr. Chariker is not an advocate of this. The AAP does not recommend using any devices that may restrict the movement of an infant’s head.

In addition to alternating sides, you may want to consider moving your baby’s crib to a different area of the room. If there’s something in the room (a window or toy, for example) that is catching his attention and causing him to hold his head in a similar position day after day, moving his crib will force him to look at it from another position.

Always be sure your baby gets plenty of time on his stomach during the day, especially while he is awake and you are nearby. Not only does ‘tummy time’ give the back of your baby’s head a rest, it also helps in other ways. Looking around from a new perspective encourages your baby’s learning and discovery of the world. Plus, being on his stomach will help him learn to push up on his arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen his neck muscles.

If torticollis is the cause of your baby’s flattened head, a course of physical therapy combined with a home exercise program will usually lead to improvement or resolution. A physical therapist can teach you exercises to do with your child at home. Most exercises will consist of stretching your child's neck to the side opposite the tilt. Eventually, the neck muscles will be elongated and the neck will return to the upright posture. Rarely, surgery is needed to correct the problem. If indicated, Dr. Chariker will release the contracted muscle. Note that the ear asymmetry created by the torticollis may require several years to improve.

For children with severe positional plagiocephaly, Dr. Chariker may prescribe a custom molding helmet or head band. These work best if started between the ages of four and six months, when your child grows the fastest and are usually less helpful after 10 months of age. They work by applying gentle but constant pressure on a baby’s growing skull in an effort to redirect the growth. Remember that these devices are dynamic orthotic devices, but the true dynamic component of this therapy is the brain growth. The helmet remains static while the brain is growing and helping shape the head. The average duration of use is between three to four months. You should never purchase or use any devices like helmets or bands without having your child evaluated by a doctor first.