What is Plagiocephaly?

Baby flat head, better known as plagiocephaly, is characterized by a flattened area of the head in an infant.

In 1992, the American Academy of Pediatrics began the 'Back to Sleep Campaign' to help reduce Sudden Infant Death Syndrome (SIDS).

Since the inception of the program, there has been a reduction in SIDS by approximately 40%.

Because infants have been encouraged to sleep on their backs, there has been a significant increase in babies with flat spots.

Counter-positioning and helmeting are two avenues used to help reshape the flattened area.

Some of the common causes of a baby's flat head include:

• Sleeping in one position from birth through the first few months can change the head shape.
• Torticollis can be defined as the bending of the neck to one side and rotation in the opposite direction. This results in the infant sleeping constantly in one position, thus possibly resulting in a flat spot. Therapy, which includes stretching the sternocleidomastoid muscle, will help restore proper neck movements.
• Limited space in the womb may result in a flat spot before birth. Torticollis can also occur in the womb due to positioning. A baby's flat head and torticollis can also occur during the birthing process. In this case, there may be trauma as the baby moves through the birthing canal.

Counter-positioning

Counter-positioning: Placing your baby on the part of the head that is not flat is the first line of defence to help reshape the head. If started early enough, the mild flat spot may correct itself since the head is growing. The best time to start counter-positioning is before 5 months of age, since the baby hasn't developed the muscle strength to override pads/towels, etc.

It is very important to use counter-positioning techniques when the baby is sleeping or lying on their back. Always avoid the baby sleeping on its stomach. Some will use a rolled-up towel to tilt the baby at a 45-degree angle to avoid contact on the flat spot. Placing toys on the opposite side of the crib to encourage turning away from the flat spot is also effective when the baby is awake. Speak to your pediatrician about these counter-positioning techniques.

Try also to make sure that your baby does not spend too much time in a baby car seat. In this situation, your baby may still favour lying on the flat spot for long periods of time.

Supervised tummy time a few times a day is another way of keeping your baby off the flat spot. It is also very important in helping the baby interact and gain neck and shoulder muscle strength. It will not be their favorite position at first, but with time, they will like it.

Check with your physician/pediatrician to see if torticollis is also present. This could contribute to plagiocephaly and should be addressed right away. Torticollis will be addressed in a future blog.

Counter-positioning can be a very useful technique to reshape the head of a baby with mild plagiocephaly. Results can be seen within a month or so if the techniques are followed. If counter-positioning is not effective, helmeting would be another option.

Helmet for Plagiocephaly

The use of a helmet for plagiocephaly is another effective way to reshape the head if counter-positioning has not been successful. Usually, for mild plagiocephaly, counter-positioning is a viable option and should be tried first if a child is 3 to 6 months of age. If head shape does not improve, then a helmet is another option. The optimal time to start helmeting is between 5 and 6 months of age.

For moderate to severe plagiocephaly, helmet use may be the first option, especially if the client is 6-10 months of age. Time is of the essence since head growth has such a short window (80% is grown in the first year). It is during growth that the head shape can be influenced.

Remember, every child is different, so these are just basic guidelines. See your orthotist, family doctor, or physiotherapist regularly to monitor the progress of the head shape.

Please contact us for more information on plagiocephaly and infant hemets