Bringing a baby home from the hospital can be a scary time for parents during the first few months as an expanding family. The list of things to worry about as a child develops can seem endless, and the baby’s head shape may be on that list. Often the head shape issue is caused by a benign condition called Positional Plagiocephaly. Your doctor will help you make sure this isn’t caused by a more serious condition called Craniosynostosis .
What is Positional Plagiocephaly?
When babies are born, their skulls are soft, which helps them pass through the birth canal. It can take 9-18 months for a baby’s skull to fully form. During this time, some babies develop positional plagiocephaly. This condition is also known as flat head, trapezoid head, flat head. This means there is a flat area on the back or side of the head. Positional plagiocephaly does not affect brain growth or development; This is entirely a matter of shape.
Causes of Positional Plagiocephaly?
A flat area on the back or side of the head is usually caused by repeated pressure on the same area. This often happens when a child chooses to rest his or her head in the same spot, which causes the head to distort. Other reasons include:
- Position of the baby in the womb that puts pressure on the baby’s head
- More than one baby in the same pregnancy; birth of twins, triplets
- Spending too much time lying on your back
- Torticollis (a tight muscle on one side of the neck) can cause the head to tilt to one side or make it difficult to turn the head
Important NOTE: It is recommended that babies be placed on their back for safe sleep. This is crucial to reduce the risk of Sudden Infant Death Syndrome (SIDS). Babies are placed face down only with parental supervision and while awake.
How is Positional Plagiocephaly Treated?
In many children, the flattening resolves on its own as the child becomes more mobile and lies less on the affected area. Other techniques are:
- With your child lying on his back, turn his head slightly to the side that is not flat. This is the “non-preferred side.” Switching sides takes pressure off the flat spot. DO NOT use any support material to hold the head in place; It can block the face and prevent the child from breathing.
- Place a toy or velcro wrist rattle in your child’s left or right hand and encourage him to look at his non-preferred side, taking pressure off the flat side. You can also keep toys on the non-preferred side to encourage looking in that direction.
- While awake, limit the time your baby spends in a swing or baby carrier. If your child can sit, it will take pressure off the back of his head and build neck strength.
- For infants who cannot sit for long periods of time, increase supervised tummy time (prone position) while the child is awake.
- When holding your baby, make sure there is no pressure on the flattened side of his head.
In some cases, these methods do not help roll the head. In these cases, your doctor may recommend using a custom-made helmet or headband. These devices contribute to head reshaping by directing growth and are generally quite effective.
What is Craniosynostosis?
The skull consists of many different bones. The connections between bones are called sutures. Craniosynostosis occurs when one or more sutures close prematurely. Premature suture closure may cause unusual growth of the skull. Sometimes, premature closure of the sutures can be harmful to the brain that is trying to grow inside it.
If left untreated, craniosynostosis can lead to further cranial deformity and potentially an overall restriction of head growth and secondary increased intracranial pressure. It can also lead to psychosocial problems as the child interacts with peers during development.
What are the symptoms of craniosynostosis?
The most obvious symptom of craniosynostosis is typically an abnormally shaped head. The soft spot can be open or closed. Less common is the restriction of head growth by measurements that “fall off” from the pediatrician’s growth curves. This can cause pressure to build up inside the skull. Symptoms of high pressure may include:
- Headache
- Nausea
- Vomiting
- Lethargy (very sleepy, difficult to wake up)
- Difficulty lifting eyes up
- Keeping eyes down at all times (looks like the sun setting on the horizon)
- Swollen and/or tense fontanel (when the patient is upright and does not have a respiratory infection)
How Common Is Craniosynostosis?
The condition occurs in one in every 2,000 to 2,500 live births.
What causes craniosynostosis?
In most babies, the cause of craniosynostosis is unknown and the child has no other health problems. Sometimes the cause is familial or genetic. Here, there is a change in one or more genes that will cause the condition.
How Is Craniosynostosis Diagnosed?
Craniosynostosis can be easily diagnosed by pediatricians. In suspected cases, imaging methods such as x-ray or tomography will be used to examine the cranial sutures more closely and confirm the diagnosis.
How Is Craniosynostosis Treated?
Treatment for craniosynostosis usually involves surgery to unlock the bones and reshape the skull. Historically, craniosynostosis has been treated using surgical methods that involve an incision from ear to ear and the removal, reshaping, and reattachment of the affected bones. Sometimes this is still the best option. However, today, much less invasive methods are also used in endoscopic craniosynostosis procedures. If left untreated, the head shape will likely deteriorate, but more importantly there is a risk of general head growth restriction with the development of increased pressure on the brain.