Plagiocephaly
Abnormal head shape can be a confusing and fearful hurdle for new parents. Luckily, it’s a treatable and manageable condition. Below are answers to the questions that we hear most frequently.
What is Positional or Deformational Plagiocephaly
Plagiocephaly is referred to as the flattening or deformation of an infant’s head. Many factors contribute to the cause of positional or deformational plagiocephaly, including premature births, multiple births, restrictive intrauterine positioning, torticollis, trauma at birth, and cervical spine abnormalities.
When an infant is born, their skull is very malleable. The malleable nature of an infant’s head allows for passage through the birth canal and the rapid growth experienced during the first year of life. Unfortunately, the malleable nature also presents the potential for plagiocephaly. Thorough physical examination and evaluation of the infant is done to rule out other diagnoses such as craniosynostosis (a premature fusion of the skull sutures).
What is torticollis and how does it affect plagiocephaly?
85% of infants diagnosed with plagiocephaly also show signs of torticollis. Torticollis refers to a tightness or shortening of a muscle called the sternocleidomastoid. This muscle, located on the side of the neck, is responsible for forward flexion and lateral bending of the head. When torticollis is present, it causes the infant to continually rest his/her head in the same position. Repetitive pressure can create or contribute to a flattening of one side of the skull and, consequently, a prominence on the opposite side.
What is craniosynostosis?
The plates of an infant’s skull are connected by soft, malleable sutures that naturally fuse together into rigid connections as the child grows. In some infants, this natural fusion and hardening occurs prematurally, resulting in craniosynostosis. Craniosynostosis can cause development complications and should be addressed by a pediatric and/or cranio-facial specialist.
How is plagiocephaly diagnosed?
Performed by a pediatrician and/or a cranio-facial specialist, a physical evaluation of the infant’s skull reveals and records the deformity. Measurement techniques can determine the asymmetry of the skull and facial features. In severe cases, imaging techniques such as radiographs (x-rays) and CT scans can be used to determine appropriate diagnosis and treatment recommendation.
Will plagiocephaly hurt or delay my baby’s development?
In most cases, plagiocephaly does not affect normal development of the infant’s brain. Specialists, such as cranio-facial surgeons, cranio-facial abnormalities teams, or pediatric neurosurgeons, can provide proper diagnostic techniques to best assess your baby’s needs.
Why is there an increase in the amount of infants diagnosed with plagiocephaly?
In 1992, the American Academy of Pediatrics initiated the “Back to Sleep” program, recommending back and side sleeping positions as opposed to the traditional prone (i.e. tummy) sleeping position. While the program decreased the incidence of sudden infant death syndrome (SIDS) by nearly 40%, it promotes supine (on your back) sleeping positions that, in combination with playtime, car seats, and infant carriers, contribute to the increased incidence of plagiocephaly.
What are my options and what treatment is best for my baby?
Plagiocephaly is often classified as mild, moderate, or severe. Consult a pediatric specialist for an accurate diagnosis and treatment protocols.
Mild plagiocephaly
- Occurs in many births due to the confines of the womb and the birthing process.
- Often resolved by three months of age with proper physical therapy and positioning techniques.
Moderate to severe plagiocephaly
- Often treated with cranial remolding techniques (e.g. Hanger Cranial Band) and physical therapy.
Severe plagiocephaly
- Relatively rare condition resulting from craniosynostosis.
- Consult a pediatric specialist for appropriate treatment options.
What are the physical therapy and positioning treatments for plagiocephaly?
Physical therapy and positioning treatments are often used alone to treat mild plagiocephaly and in combination with orthotics to treat moderate to severe cases.
A typical treatment plan involves stretching, repositioning the infant’s head away from the deformity and tilted position, and massage. Physical therapists develop at home therapy programs that instruct proper positioning techniques and additional exercise to facilitate symmetrical movements and developments.
Encouraging “tummy time” is also done to prevent unwanted pressure on the back of the infant’s head and to help infants gain head and neck control.
When is surgery an option?
Surgery is usually not recommended for deformational plagiocephaly. However, in severe cases where non-surgical treatments have proven ineffective and deformity presents developmental complications, surgery may be recommended.
Surgery is typically appropriate for infants who are diagnosed with craniosynostosis.
What is the Hanger Cranial Band?
The Hanger Cranial Band is a FDA approved device used to treat deformational plagiocephaly. Cranial remolding bands are most effective with infants 4-18 months of age. During this developmental stage, the infant’s skull is malleable to allow for rapid brain growth. Cranial bands may be worn until 24 months of age. After this time, the bones of the skull have fused and orthotic treatment is ineffective. If plagiocephaly and torticollis are both present, it’s common to combine orthotic cranial remolding techniques with physical therapy.
Is the cranial band painful for my baby?
No. Cranial remolding is not achieved by placing severe pressures on the skull. The cranial band applies a constant, static pressure over the areas of the skull that are most prominent. Opposite of this, the band has open areas where the flattened section of the skull can grow. To ensure that appropriate modifications as your baby develops, it is important you follow your practitioner’s guidelines for follow up care.
How do you make the Hanger Cranial Band fit my baby’s head?
Hanger Cranial Bands are custom made to fit the individual shape of each baby’s head. There are two Hanger Cranial Band fitting methods—plaster casting and Insignia™ laser scanning.
- The plaster casting method obtains an exact replica of your baby’s head by applying a removable plaster cast.
- Insignia, exclusively created for use by Hanger practitioners, is a portable laser-scanning device with three-dimensional imaging programs that allow your baby’s head to be scanned and instantly recreated as a 3D image on a laptop. This eliminates plaster casts and the stressful cast removal procedures. Your baby can be scanned while comfortably sitting in your lap.
What is Insignia and how does it work?
Insignia (see description in question above) works by casting a fan of laser light over the baby’s head, recording a cross-sectional profile of the head, and instantly reconstructing the full three-dimensional surface of the baby’s head on the screen of a laptop computer. Thanks to the two motion-tracking devices, your baby is able to sit in your lap and move his/her head while being scanned. Accurate to within one millimeter, the 3D feature gives detailed surface information that is critical for creating the Hanger Cranial Band.
Does the Insignia scan hurt?
No, the laser scanner emits a low intensity fan of laser light that is harmless to the human body. The Insignia laser does not produce any type of physical sensation.
How long does my baby need to wear the Hanger Cranial Band?
It is common for most infants to wear the cranial band for 22-23 hours a day up to 18-24 months of age.
How many times will I have to see my practitioner?
As your baby grows, adjustments are necessary. Follow-up visits are required to ensure proper fit and the best clinical outcome for your baby.
How do I clean the Hanger Cranial Band?
The soft foam lining of the Hanger Cranial Band does not absorb water or perspiration. It should be cleaned daily with a cloth dampened with rubbing alcohol. Do not use soap and water; soap residue can lead to skin irritations. To help prevent irritations please make certain the band is completely dry prior to putting it on your baby.
Are these treatments effective?
Results are dependent upon the severity of the deformity, the time of diagnosis, how often the treatments are implemented, and the presence of craniosynostosis and/or other medical complications. If the deformity of the skull is mild to moderate, the result of physical therapy and orthotic intervention is often very favorable.
Will insurance pay for the Hanger Cranial Band?
Insurance reimbursements vary between state and provider. Your local Hanger practitioner can assist in obtaining reimbursements.