Plagiocephaly is a term that is derived from the Greek plagio—slanted or oblique—and kephale—head. Literally, it means slanted, or crooked head. In general, this term is applied to an abnormally-shaped head. Plagiocephaly can be caused by premature fusion of the cranial sutures (see Craniosynostosis) or, much more commonly, by external forces that deform the malleable infant skull. These external forces may be due to pressure on the skull in utero, pressure from repetitive sleep positioning, or related to abnormal head posture that is secondary to a problem with the eyes or the muscles of the neck. Posterior deformational plagiocephaly (flattening of the back of the head) has become quite common since the American Academy of Pediatrics recommended that infants be positioned on their backs to sleep.
- Is this condition painful?
- Are there different types Deformational Plagiocephaly?
- Lots of babies have slightly abnormal head shapes; how do I know when it is something to worry about?
- Who gets Deformational Plagiocephaly?
- What are the main issues related to Deformational Plagiocephaly?
- What is the treatment for babies with Deformational Plagiocephaly?
- What sorts of specialists will be involved in my baby’s care?
- What sorts of specialized equipment will be involved in my baby’s care?
No, deformational plagiocephaly causes no symptoms.
In general, plagiocephaly can affect the forehead (anterior plagiocephaly) or the back of the head (posterior plagiocephaly). Posterior plagiocephaly is much more common because babies are usually positioned on their backs to sleep.
Lots of babies have slightly abnormal head shapes; how do I know when it is something to worry about?
Abnormal head shapes in babies are quite common. In general, abnormal head shapes can be caused by either craniosynostosis (premature fusion of the cranial sutures), which is described elsewhere in this website, or by deformational plagiocephaly, which is much more common. Deformational plagiocephaly does not cause any increased pressure on the brain and is not associated with any danger to the neural development of the child. The most common form of deformational plagiocephaly is flattening of the back of the head (posterior plagiocephaly), caused by repetitive sleep positioning.
If your baby has an abnormal head shape, you should raise this concern with your pediatrician. Often the pediatrician will be able to distinguish whether your child has the much more common deformational plagiocephaly or the much less common craniosynostosis. If the pediatrician in unsure, then you should be referred to see a craniofacial surgeon, who can usually make the diagnosis by physical exam.
Deformational plagiocephaly can occur in any infant. Anterior plagiocephaly (flattening of the forehead) occurs most commonly on the left side, because the left occiput anterior position is the most common intra-uterine fetal head position. The heads of babies with anterior plagiocephaly often engage in the maternal pelvis rather early. Deformational plagiocephaly is also more common in multiple pregnancies, in which there is less space for the growing skull. Moreover, there may be molding of the skull that occurs from compressive forces during normal vaginal delivery.
Post-natally, repetitive sleep positioning can cause deformational plagiocephaly. If the baby sleeps in the same position repeatedly, the skull will become flattened on the side on which the baby sleeps. In addition, some eye muscle imbalances cause infants to tilt their heads to achieve binocular vision, and this head tilt can also result in deformation from repetitive positioning. Similarly, torticollis (tightness of the sternocleidomastoid muscle in the neck) can cause a head tilt with the same result.
Deformational plagiocephaly is essentially a cosmetic deformity. There are no issues related to the growing brain or to intellectual ability. However, as noted above, there may be underlying causes of deformational plagiocephaly, such as ocular problems or torticollis that must be investigated and addressed. In severe cases, the deformity may become a source of psychosocial stress for the child as he or she grows.
Most babies can be treated with modification of their sleep positioning. The goal is to relieve pressure on the flat area of the head. By using positioning devices, such as foam wedges, and by changing the orientation of the child’s crib, pressure can be relieved and the shape of the skull will gradually correct itself. In infants with ocular problems, eye muscle surgery may be required to correct the head tilt. For infants with torticollis, usually a physical therapy program of stretching will correct the head tilt; in some cases, surgical release of the tight neck muscle is required.
When it seems that these maneuvers are ineffective, molding helmet therapy can be used to treat deformational plagiocephaly. The baby is fitted for a helmet that gently reshapes the skull. The helmet is adjusted at regular intervals, and must be worn twenty-three hours per day for several months. Helmet therapy is most effective if it is instituted before approximately ten months of age.
In extremely rare cases of very severe deformities, surgical reconstruction of the deformed skull is performed.
Babies with deformational plagiocephaly are seen primarily by the craniofacial surgeon and the neurosurgeon. When molding helmet therapy is used, the baby is seen frequently by the orthotist, who makes the helmet and modifies it as needed.
The University of Missouri Center for Craniofacial Anomalies now has a STARscanner™ Laser Data Acquisition System in our clinic. This FDA-approved device allows us to quickly, safely, and easily perform a 3-D surface scan of a baby’s head shape. The 3-D information can then be viewed in multiple planes. The scanner uses an eye-safe laser, and the scan takes less than 2 seconds to complete. For infants with deformational plagiocephaly, the data obtained from the scan can be used to create the cranial molding helmet and to very exactly measure the improvement in head shape at each visit. For infants with craniosynostosis or other diagnoses that affect head shape or growth, the STARscanner allows us to accurately measure and track changes in head shape and growth to help make treatment decisions and to document the effect of treatment on the cranium. Having this technology in our clinic will enable our patients to see Dr. Muzaffar, have their scan, and see the orthotist who will be involved in the fabrication and adjustments of the helmet all in one place and at one visit.