Plagiocephaly FAQ
What is congenital muscular torticollis and how does it contribute to 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. Many times car seats, bouncy seats, swings, etc. can contribute to this condition. It is very important to not allow your baby to sit or lay in the same position with his/her head turned the same direction for long periods of time.
What is craniosynostosis?
Craniosynostosis is a congenital anomaly in which one or more of the fibrous joints between the bones of an infant's skull close prematurely, before the infant's brain is fully formed. As a result of craniosynostosis, your baby's brain can't grow in its natural shape and his or her head is misshapen.
Craniosynostosis can affect one or more of the joints in an infant's skull.. Most children with craniosynostosis do not have any symptoms; the head shape is abnormal, and the face may be malformed in certain cases.
Rarely, symptoms of increased pressure in the head such as headaches, decreased appetite, vomiting, or even developmental delays or mental retardation may occur. Treating craniosynostosis requires that your infant undergo surgery to separate the fused bones. If there's no underlying brain abnormality, the surgery allows the brain adequate space to grow and develop.
Will deformational plagiocephaly hurt or delay my baby’s development?
In most cases, plagiocephaly does not affect the normal development of an infant’s brain. Specialists, such as craniofacial surgeons or pediatric neurosurgeons, can provide proper diagnostic assessments to help determine if there are any special needs to be considered.
Why is there an increase in infants diagnosed with deformational plagiocephaly?
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 deformational plagiocephaly.
Is the cranial band painful?
Cranial remolding is not painful. The cranial band applies a constant static pressure over the area of the skull that is most prominent, rather than severe pressure on the skull. The band also has open areas to allow the flattened areas of the skull to grow. To ensure appropriate modifications are made as your baby develops, it is important to follow your orthotist’s guidelines for follow up care.
How often will we need to have the band refitted? Does this mean getting a new band?
Every infant and each case is very unique; your orthotist will need to determine the best refitting schedule to meet your infant’s specific needs.
How can I prevent deformational plagiocephaly?
There are many factors that contribute to the development of deformational plagiocephaly, some of which are beyond your control. However, there are a number of daily activities that can be done to minimize and, in some cases, prevent this type of skull deformation. A few simple suggestions are listed below:
• Your infant should spend as much time as possible each day with supervised “tummy time”. This activity can be incorporated into play time, peek-a-boo, or any other interaction that encourages the infant to lift and turn their head.
• Limit time in seating devices such as swings, carriers and other designs that maintain the pressures on the back of the head. If these devices are necessary, then try to reposition your infant from time to time to vary the pressures.
• Alternate placement of the infant on the changing table, specifically placing their head to the opposite end of the table with each diaper change.
• Alternate carrying your infant in your right and left arms.
• If you infant has a positional preference – looking mostly to the right or the left – arrange the crib in the nursery so that your infant is encouraged to look in the opposite direction of the preference in order to see the window. Babies are attracted to light sources and even simple practices such as this have a significant effect in the early months.
Additional ideas and suggestions may be unique to your infant and can be discussed with your orthotist, physical therapist and/or physician. There is also an enormous amount of repositioning ideas available on the internet.
Tummy Time
Since babies sleep on their backs and spend a lot of their time in bouncy seats and swings most do not like tummy time. When an infant is on his tummy it is an unfamiliar and can be physically uncomfortable. However, babies who do not spend time lying on their stomachs may have developmental delay and can also be prone to the development of plagiocephaly or brachycephaly.
Here are a few tips for successful tummy time:
Keep your baby company and provide entertainment. Try lying on the floor with your baby and entertain with toys, mirrors, books and games such as peek-a-boo.
Prop your baby up with a nursing pillow or rolled up blanket under his/her arms. This will give your baby a better view and help build upper body strength and neck control.
Try not to schedule tummy time when your baby is too hungry or too full.
Your baby may not like tummy time in the beginning and may fuss or cry. If this happens, just try to make tummy time a routine and slowly add a little more time each day. When you baby is able to roll over it will help make the experience more pleasurable.
Talk to other moms and dads. Other parents are a great resource for ideas and guidance. Be sure to inform your daycare, baby sitter or caregiver about the importance of tummy time.