Abnormal Head Shape (Deformational Plagiocephaly)

What is Deformational Plagiocephaly?

Deformational Plagiocephaly is the term used to describe the flattening of part of an infant's skull due to external pressure. It is most often related to a supine sleeping position although occasionally it can occur in utero, particularly in twin pregnancies.

Plagiocephaly has become more common since the introduction of a successful campaign to position babies on their back to reduce the incidence of Sudden Infant Death Syndrome (SIDS). Deformational Plagiocephaly is not a medical problem; it has no influence on brain growth and is usually treated by simple measures. The SIDS guidelines for babies sleeping position should still be followed.

How does it occur?

The infant skull is made of flat plates of bone that can shift and mould to allow passage through the birth canal. The joins between the bone plates are known as sutures. Skull growth occurs at these sutures, in response to pressure from the growing brain. If a baby is regularly positioned with pressure on the same part of the head the skull shape will mould to become flattened in that area.

Occasionally a tight neck muscle prevents a baby from turning their head to one side and results in Plagiocephaly. This neck tightness is known as a Torticollis and in most cases is successfully treated by a Physiotherapist, with referral to a Specialist Plastic & Reconstructive Craniofacial Surgeon if severe or fails to improve with physiotherapy.

What does Deformational Plagiocephaly look like?

The most common appearance is a flattening of the back of the head either on one side or across the midline. If one side is flattened the ear on that side may also be pushed forward, and the forehead on that side may seem more prominent.

How do I know this is the right diagnosis?

Deformational Plagiocephaly is a common problem and is usually quite straightforward to diagnose on the basis of the features above. A skull X-Ray can help with the diagnosis if required.

More rarely serious skull deformities that require medical intervention occur when the joins between the bone plates are fused. This is known as Craniosynostosis, and results in abnormal head shapes that are usually quite distinctive and different to those seen with Deformational Plagiocephaly. Clinical examination by a General Practitioner and skull X-Rays are needed if Craniosynostosis is suspected, and referral to a Craniofacial Surgeon maybe required. More information about Craniosynostosis is available on this website.

How is Deformational Plagiocephaly treated?

It is very important that babies are put to sleep on their back as suggested by the guidelines for prevention of SIDS. Despite this Plagiocephaly can be prevented or treated by using measures to prevent ongoing pressure to same side of the head. Your GP, or child health nurse can suggest some techniques, they include:

  • turning the cot to face the opposite side of the room and placing the toys in the room on the opposite side to encourage head turning away from the flat side.
  • supervised tummy time
  • avoidance of long periods lying in car seats, cradles or rockers

Using these measures, and as babies get older and develop more head control and sit independently the head shape usually begins to normalise. However in some children despite this, there may be always be a tendency for a flatter area on the skull and with hair growth this is often well hidden.

Are there any other treatments for Deformational Plagiocephaly?

An orthotic molding helmet maybe of additional benefit in some children. Private companies that specialise in orthotics make and fit the helmets. In Queensland these include GB Orthopaedics and Brisbane Prosthetics and Orthotics (BPO). You do not require a Specialist referral for a helmet because helmets are not usually covered by Medicare.

Surgery is not required for Deformational Plagiocephaly.

What age should my baby be treated?

To correct Deformational Plagiocephaly the best results are achieved when pressure relieving measures, or helmets, are introduced during the time of rapid brain and skull growth; ideally well before 8 months of age.

What if I need more information?

If your child appears to have Craniosynostosis or you have other concerns about your baby's head shape Dr O'Mahony would be happy to provide her opinion. You will require a referral from your General Practitioner. Please contact us Dr O'Mahony's office for a consultation. 

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