What is Plagiocephaly?

Deformational, or positional, plagiocephaly is when a baby develops a flat spot on one side of the head or the whole back of the head. It happens when a baby sleeps in the same position most of the time or because of problems with the neck muscles that result in a head-turning preference.

You may notice the back or one side of a baby’s head becoming flat. The condition can cause the baby’s head to look asymmetrical. Some describe the head as looking like a parallelogram when observed from above.

A baby’s skull bones don’t fully fuse and harden until several months after birth. Soft, pliable bones allow for easier passage through the birth canal and give a baby’s brain ample room to grow. On the other hand, these soft bones also mean that a baby’s head can change shape. One common cause of flat head syndrome is regularly sleeping or lying in the same position.

Signs and Symptoms

• A flattened area on the side or back of the head. Instead of being round, the head may appear slanted in a certain area.
• Ears that aren’t even. A flattening of the head can cause the ears to appear misaligned.
• A bald spot in one area of the head.
• Bony ridges on the skull.
• Lack of a soft spot (or fontanel) on the head.

Types of Plagiocephaly

• Positional plagiocephaly and congenital plagiocephaly. Positional plagiocephaly, also called deformational plagiocephaly, is the most common type of flat head syndrome. Worldwide, it affects up to 50 percent of babies.
• Congenital plagiocephaly, also known as craniosynostosis, is a rare birth defect. In babies with this condition, the fibrous spaces between the skull bones, known as sutures, prematurely close. This results in an abnormally shaped head. Congenital plagiocephaly occurs in one out of every 2,000 to 2,500 births.

Causes

Sleeping position

• Putting your baby to sleep in the same position day after day, for example, on their back or with their head facing right or left, puts consistent pressure on the same parts of the skull. Babies are most at risk of positional plagiocephaly in the first four months of life before they have the ability to roll over by themselves.
• It’s recommended to always put your baby to sleep on their back to reduce the risk of sudden infant death (SIDS). To reduce the risk of plagiocephaly, give your baby ample tummy time while they are awake. Spend time carrying your baby, either in your arms or a carrier, instead of having them lie down for extended periods of time. A bouncer or baby seat can also help to reduce their risk.

Insufficient time spent on the stomach

• Plagiocephaly is more likely the more time your baby spends on their back. Adequate tummy-time, while you are awake and watching them, can help reduce their risk of this condition.
• Your baby may cry when you put them on their tummy, but it’s important to offer several tummy-time sessions a day. When your baby is awake, place them on their tummy atop a blanket or mat. Start with a few minutes per session, and a few sessions a day. As your baby develops more muscle strength and neck control, you can increase the session duration.
• Tummy-time can also help your baby to build the strength and muscles necessary for rolling over, crawling, sitting up, and, eventually, walking.

Preterm Babies and the Risks of Flat Head

Babies born prematurely have softer bones than those born at term. They are also more likely to have lengthy hospital stays where they spend much of their time lying on their backs. Positional plagiocephaly is more common in premature babies than in full-term babies.

Forceps or vacuum delivery

These instruments put pressure on the skull and its malleable bones, which could lead to plagiocephaly.

Muscular torticollis

This is a condition in which an infant’s neck muscles are stiff or imbalanced. It’s often caused by limited space in the uterus or being in a breech position.

Remedies

• Change your baby's position frequently. Don't let her spend too much time in one spot. Even if you're at home, try to move your baby from the swing to the bouncer, or to the floor for instance. Be sure not to let him spend too much time sleeping in places that aren't his crib, such as the car seat, for example.
• Practice lots of supervised tummy-time. Aim for at least twenty minutes a day, but the more the merrier, especially if you are concerned your baby may be developing a flat head.
• Try a baby carrier. Using a baby carrier that allows your baby to face in, towards your chest, can help take some of the pressure off your baby's head and work on strengthening those neck muscles all at the same time.
• Use a Cloth Cradle: An interesting suggestion given by our Acharyas is to allow the baby to sleep in a rock-able cradle/jhula for at least some part of the day.  This helps in shaping the baby's head to a round shape. especially useful for flat head babies.
• Use a Mustard seed pillow: It has been traditionally used for newborn babies. It gives support and good shape to your baby’s head. As the pillow is filled with seeds, the pillow shapes according to the baby’s head movements. So if your baby moves to the right, the seeds adjust their positions to give support while maintaining their shape. This helps to reduce the pressure on your baby’s head. Little dents, uneven surfaces, and bumps can be easily fixed using this pillow. The pillow allows air circulation and confirms the shape of the baby's head thus preventing flat head syndrome. Also, it has warming properties that will prevent your babies from coughing and cold. Mustard seed has natural warming properties, increases blood circulation, reduces ear infections, and soothes the sinuses. It is believed to keep away the common cold from babies as mustard seeds have natural warming properties. Caution: pillows can cause SIDS in babies. However, a thin mustard seed pillow can be safe if you keep checking on your child regularly. Do not use this pillow in peak summer times. Also, these pillows can be used as therapy for some hours of the day and not regularly.
• Try counter-position therapy: while it’s important to always put your baby to sleep on their back to reduce the risk of SIDS, be mindful of changing their position. For example, if your baby favours sleeping with their left cheek flat against the cradle mattress, position their head so that they sleep on their right cheek.
• Plan some Exercises: if your baby has muscular torticollis, your doctor may recommend stretching exercises to increase the range of motion of the neck. Never try neck-stretching exercises without your doctor’s approval and directions.
• Plan a Surgery: surgery isn’t usually needed in cases of positional plagiocephaly. It’s needed in most cases of congenital plagiocephaly when sutures have closed and pressure in the skull needs to be released.