Introduction:
Plagiocephaly refers to the “oblique head.” The term plagiocephaly is derived from the Greek word “plagios,” meaning oblique, and “kephale,” meaning head. Plagiocephaly, or the “ flat head syndrome,” is when the baby’s head has a flat spot and appears to be flattened. This plagiocephaly can be categorized into two types based on its origin.
What Are the Two Types of Plagiocephaly?
-
Synostotic or congenital plagiocephaly.
-
Deformational or positional plagiocephaly
What Are Synostosis and Deformational Plagiocephaly?
1. Synostosis Plagiocephaly: The International Classification of Diseases (ICD) has isolated the synostotic type as a form of non-syndromic craniosynostosis. They are caused due to the premature closing of the coronal or lambdoid suture. This causes skull deformity and facial asymmetry. This is a rare type of plagiocephaly. They are further subdivided into:
- Anterior Plagiocephaly: It is due to the premature closure of coronal suture.
- Posterior Plagiocephaly: It is due to the early closure of lambdoid sutures.
2. Deformational Plagiocephaly: Deformational plagiocephaly is due to the deformative forces resulting in asymmetry. The forces may be acquired in intrauterine or postnatal life. It is also called positional plagiocephaly and is a common type.
What Causes Plagiocephaly in Your Child?
The cause of congenital plagiocephaly is usually unknown. It may be due to genetic reasons or syndromes such as Pfeiffer or Crouzon syndrome. Metabolic conditions such as hypophosphatemia, hyperthyroidism, exposure to teratogens, and valproic acid may also cause congenital plagiocephaly. Most commonly, deformational plagiocephaly occurs when the baby sleeps in the same position for a longer duration of time and the skull softens. This is more common during the first month after birth. Many times the baby may be born with a flattened head due to the tight spaces in the uterus. This risk is increased in the case of twins and multiples. Some of the other causes are:
-
Premature Infants: The bones of the skull are even softer in premature babies. When they spend a lot of time on respirators with the same head position, they develop a flattened head.
- Muscular Torticollis: It is a congenital problem where the neck muscles are stiff, so the babies tend to sleep in the same position for a longer duration.
- Vaginal Delivery: Sometimes, the newborn’s head is molded unevenly while passing through the birth canal, but this may get resolved over time.
Who Is at High Risk?
-
First born child.
-
Male infants.
-
Babies born with the help of instruments such as forceps and vacuum extraction may develop this condition.
How Does Your Baby Look With Plagiocephaly?
-
The flattened area at the back, side, or front part of the head.
-
Absence of hair in one particular area.
-
Slanted head.
-
Uneven ears, one ear may be pushed upwards.
-
Squint eyes may be noticed.
In the case of congenital plagiocephaly, the following may be noticed:
-
The soft spot called the fontanelles will be absent.
-
Bony ridges may be prominent along the suture line.
-
Bulging of the forehead, uneven cheekbones, and lower jaws.
-
Blood vessels on the scalp may be prominent.
-
Poor feeding and forceful vomiting.
-
In cases of severe plagiocephaly, seizures may be present.
What Causes Seizures In Plagiocephaly?
In the case of congenital plagiocephaly, increased intracranial pressure may be seen in 15 % to 20 % of infants with coronal or lambdoid synostosis. This increased intracranial pressure may result in papilledema and seizures. This chronic increase in the intracranial pressure may lead to blindness and subnormal intelligence. Papilledema is a sign of raised intracranial pressure.
Is Plagiocephaly a Serious Condition to Worry About?
Generally, deformational plagiocephaly is not a serious condition but may be a cosmetic concern. This may get corrected by changing the baby’s sleep position and any external factors.
However, congenital craniosynostosis may cause serious health problems. It may be a sign of any syndrome or developmental disorder.
How to Diagnose Plagiocephaly?
by looking at your baby’s head. The doctor also does a physical examination of your baby’s head from all positions and detects any abnormalities, particularly along the suture lines. The movements of the neck are also assessed to identify muscular torticollis. The baby’s head circumference is also measured to rule out the severity.
What Are the Other Diagnostic Procedures to Rule Out Craniosynostosis?
The deformative plagiocephaly may be easier to identify as it occurs after birth. But it may be difficult to diagnose craniosynostosis. So some special tests may be required to diagnose congenital plagiocephaly. They are:
-
X-Rays: To check for fused sutures or ridges along the suture line.
-
Computed Tomography (CT) Scans: If X-rays do not give detailed information, then computed tomography may be advised.
-
Genetic Tests: To identify the syndromes that cause craniosynostosis.
Can We Prevent Plagiocephaly?
As the cause of craniosynostosis is unknown, it cannot be prevented. However, deformative plagiocephaly can be prevented by the following measures. They are:
-
Change your baby’s head position frequently during sleep.
-
Increase your baby’s tummy time while awake.
-
Use special pillows and mattresses that create less pressure on the baby’s head. These special pillows are available in the market and they help provide support to the head and neck.
-
Holding the baby in an upright position.
-
Rotate sides during feeding to prevent torticollis.
How Can This Be Treated?
Deformational plagiocephaly may be treated by non-surgical methods.
-
Changes in the Position: Change your baby’s head position often while sleeping. This prevents the forces onto the same side, thus preventing plagiocephaly.
-
Exercises: Sometimes, doing neck exercises relieves tension in the case of muscular torticollis. This exercise will be taught by a pediatric physiotherapist.
-
Plagio Cradle: It is a special device designed to correct head deformities. It is used in infants three months of age. The plagio-cradle is placed under the baby’s neck while lying on the back. It supports the neck and creates a hollowed space that reshapes the baby’s head and allows it to grow correctly. They are used for both the prevention and treatment of flattened heads.
-
Helmet Therapy: They are effective from four months to eight months of age for moderate to severe cases of plagiocephaly. These are prescribed by licensed practitioners and need periodic adjustments. The helmet is a light weighted plastic shell with a foam liner. It does not hurt your baby but gently corrects the shape by allowing growth in flattened areas.
These treatment protocols are for positional plagiocephaly, where only minor treatment is required. In the case of craniosynostosis, surgery is advised. The treatment aims to relieve the pressure inside the head and provides room for the growing brain. So, surgery before the age of one is recommended for normal skull and brain growth, followed by helmet therapy to reshape the skull.
Conclusion:
Deformational plagiocephaly is not a serious problem that parents have to worry about. If you notice your child’s head is misshapen, then talk to your doctor about it. Early diagnosis and appropriate treatment can prevent esthetic sequelae in your child. Your child’s doctor may create an awareness regarding the positions of your baby, thus preventing deformational plagiocephaly. If you notice plagiocephaly right from birth, then immediately take your child for an examination which may rule out any serious problems. And parents need not panic; development in medicine is so advanced that your child can be treated for any cause.
