Deformational Plagiocephaly
What is deformational plagiocephaly?
Deformational (or positional) plagiocephaly refers
to a misshapen (asymmetrical) shape of the head (cranium)
from repeated pressure to the same area of the head.
Plagiocephaly literally means "oblique head"
(from the Greek words "plagio" for oblique
and "cephale" for head).
How is deformational plagiocephaly different from
craniosynostosis?
Craniosynostosis is premature fusion of one or more
of the sutures in the skull. True synostosis may limit
the size of the cranial vault (skull) and therefore
impair brain growth. The diagnosis is made after a
clinical evaluation by a craniofacial surgeon and/or
a neurosurgeon. X-rays and CT scans of the head may
be performed to confirm the diagnosis of craniosynostosis.
Surgery is usually the recommended treatment.
In deformational plagiocephaly, there is no fusion
of the skull sutures. It is a clinical diagnosis made
after a thorough medical history and physical examination
by a craniofacial surgeon or neurosurgeon. X-rays
and/or CT scans are usually not necessary. Treatment
of deformational plagiocephaly generally includes
positioning and/or helmeting.
The major differences between craniosynostosis and
deformational plagiocephaly are summarized in the
chart below:
What causes deformational plagiocephaly?
By keeping an infant's head in one position for long
periods of time, the skull flattens (external pressure).
Occasionally, a baby is born with this flattening
because of a tight intrauterine environment (i.e.,
in multiple births, small maternal pelvis, or with
a breech position). Other factors which may increase
the risk of deformational plagiocephaly include the
following:
- muscular torticollis
One cause of deformational plagiocephaly may be
muscular torticollis. Muscular torticollis is a
congenital (present at birth) finding in which one
or more of the neck muscles is extremely tight,
causing the head to tilt and/or turn in the same
direction. Torticollis is often associated with
the development of plagiocephaly since the infant
holds his/her head against the mattress in the same
position repeatedly.
- prematurity
Premature infants are at a higher risk for plagiocephaly
since the cranial bones become stronger and harder
in the last 10 weeks of pregnancy. Also, since many
premature infants spend extended periods of time
in the neonatal intensive care (NICU) unit on a
respirator, their heads are maintained in a fixed
position, increasing the risk for this condition.
- back sleeping
Infants who sleep on their backs or in car seats
without alternating positions for extended periods
of time are also at a higher risk for deformational
plagiocephaly.
Is deformational plagiocephaly becoming more common?
The American Academy of Pediatrics (AAP) recommends
infants sleep on their backs to reduce the risk of
sudden infant death syndrome (SIDS). Since then, medical
providers have noted a significant increase in the
number of infants presenting with deformational or
positional plagiocephaly. These deformations are positional
in nature, because of the extended time an infant
spends lying supine (on his/her back) in a crib, car
seat, or infant swing.
Treatment for deformational plagiocephaly:
Specific treatment will be determined by your child's
physician based on the severity of the deformational
plagiocephaly. Frequent rotation of your child's head
would be the first recommendation once your infant
has been diagnosed with plagiocephaly. Alternating
your infant's sleep position from the back to the
sides, and not putting infants on their backs when
they are awake may also help prevent and treat positional
plagiocephaly. Some cases do not require any treatment
and the condition may resolve spontaneously when the
infant begins to sit.
If the deformity is moderate to severe and a trial
of re-positioning has failed, your child's physician
may recommend a cranial remodeling band or helmet.
How does helmeting correct deformational plagiocephaly?
Helmets are usually made of an outer hard shell with
a foam lining. Gentle, persistent pressures are applied
to capture the natural growth of an infant's head,
while inhibiting growth in the prominent areas and
allowing for growth in the flat regions. As the head
grows, adjustments are made frequently. The helmet
essentially provides a tight, round space for the
head to grow into.
How long will my child wear a helmet?
The average treatment with a helmet is usually three
to six months, depending on the age of the infant
and the severity of the condition. Careful and frequent
monitoring is required. Helmets must be prescribed
by a licensed physician with craniofacial experience.
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