Overview of Plagiocephaly

Many factors contribute to the development of deformational plagiocephaly, including premature births, multiple births, restrictive intrauterine positioning, congenital muscular torticollis, trauma at birth, and cervical spine abnormalities. When an infant is born, their skull is very malleable. This malleable nature 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 deformational plagiocephaly.

Eighty-five percent of infants diagnosed with plagiocephaly also show signs of “torticollis,” a tightness or shortening of one of the muscles located on the side of the neck. This 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 back of the skull and consequently, a prominence on the opposite side.

Types of Plagiocephaly

Deformational Plagiocephaly (pla'je-o-sef'ah-le) is referred to as the flattening or deformation of an infants head. This condition is treated without surgery typically by the use of a cranial band and physical therapy.

Plagiocephaly is not uncommon and many factors may contribute to the cause of positional or deformational plagiocephaly, including:

• Premature births
• Multiple births
• Restrictive intrauterine positioning
• Trauma at birth
• Cervical spine abnormalities
• Torticollis

Mild plagiocephaly
Mild plagiocephaly occurs in many births due to the confines of the womb and the birthing process. It often resolves by three months of age with proper physical therapy and positioning techniques.

Moderate to severe plagiocephaly
Often treated with cranial remolding techniques such as the Hanger Cranial Band and physical therapy.

Brachycephaly

Brachycephaly is often caused by sleeping on the back, which causes the back of the head to flatten uniformly, causing a wider and shorter shape. Increased head height is also common.

Prior to 1992, the risk factors associated with plagiocephaly were considered to be a restrictive uterine environment and congenital muscular torticollis. In 1992, the American Academy of Pediatrics initiated the “Back to Sleep” program, recommending back and side sleeping positions to help prevents SIDS (sudden infant death syndrome). While this program decreased SIDS deaths by nearly 40%, the supine or back sleeping in combination with car seats, infant carriers, etc. contributed to an increase in plagiocephaly.

To prevent brachycephaly or keep it from worsening it is important to provide your infant with “tummy time” every day and also make sure to position your baby differently each time he/she uses a car seat, bouncy seat, swing, etc. This will also help prevent torticollis.

Scaphocephaly

Scaphocephaly (Dolichocephaly) is characterized by a long, narrow-shaped head. This type of plagiocephaly is most common in premature babies.

Severe plagiocephaly

Severe plagiocephaly, which may also be called craniosynostosis, requires a craniofacial and/or a pediatric specialist and in most cases requires surgery.

Craniosynostosis is a congenital anomaly characterized by the premature closure of one or more cranial sutures (the fibrous joints between the bones of the skull). This disorder results in an abnormal skull and head shape. Craniosynostosis is relatively rare and can cause development complications. Craniosynostosis should be addressed by a craniofacial and/or a pediatric specialist and often requires surgery.

Torticollis

Eight-five percent of infants with plagiocephaly also show signs of torticollis which is the tightening and shortening of 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. This repeated pressure can create or contribute to a flattening on one side of the skull and, consequently, a prominence on the opposite side.