In the 1990’s, doctors started recommending that all babies be put to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS) or cot death. Since the start of this campaign, the incidence of SIDS has dropped by almost 40%. However there has been a related increase in the number of children who have developed positional plagiocephaly (or positional flat head syndrome).
What is positional Plagiocephaly?
Positional Plagiocephaly, a condition where the back or side of the baby’s head appears to be flattened, is caused by the baby resting its head for long periods against flat surfaces, including cot mattresses. Because babies’ skulls are made up of several different plates that are not yet fused together, they are much more susceptible to external pressures and are therefore prone to the condition.
Plagiocephaly occurs either evenly across the back of the head, or off to one side. This is because some babies lie with their head straight while others prefer it turned.
• Positional plagiocephaly can also occur in babies with shortened or tightened neck muscles on one side. This prevents baby’s head from turning freely and is known as congenital torticollis.
• Positional plagiocephaly can develop before a baby is even born if pressure is placed on his skull by the mother’s pelvis or from a twin.
• Premature infants are more prone to developing positional plagiocephaly because their skulls are softer and more pliant, and because they tend to spend a greater amount of time on their backs.
How is positional Plagiocephaly detected?
Typically parents notice that their baby’s head is flattened at the back or on one side.
The following could be signs of head flattening:
- head turned one way most of the time
- flat spot on back or one side of the head
- one ear more forward than the other
- asymmetry of the face
Below are examples of ways you can prevent and/or improve head flattening and help to improve your child’s neck mobility:-
- Minimise use or time spent in car seats and baby carriers – these cause a constant pressure to the back of the head.
- Use a Baby Pillow such as Clevamama’s ClevaFoam Pillow which is made from a drilled foam which is 100% breathable and incorporates Airflow technology to keep babies cool. Tests carried out at Trinity College Dublin’s Centre for Bio-engineering found that the pillow can reduce pressure on the baby’s skull by almost 50%, while allowing the baby’s head to rest in a position that does not restrict the airways. You should always supervise your baby when using a pillow.
- Ensure toys, communication and diversions are to the side to encourage them to look away from the flattened side. This applies to toys attached to the side of the cot as well as during the day time.
- Change the arm or hip you carry your baby on to encourage him to turn his head away from the flattened side.
- When feeding, hold your baby so that he has to turn his head away from the side of the flattening to feed. If in a high chair feed your child from the opposite side to the flattening.
- During nappy change, approach/change your child from the side which they tend not to look as this will encourage baby to turn its head to this side and away from the flattened side.
- When your baby is alert (after a night’s sleep or nap time), provide plenty of supervised ‘tummy time’. This is a great way to avoid pressure on the back of the head but is also an excellent developmental exercise to help improve head and neck control.
- Alternate the end of the cot you place your baby to sleep, as he is likely to look into the room, this would then alternate the side of his head that he is laying on. If there is already a flattening you should position your baby’s head away from the flattened side.
- Rearrange furniture in the nursery to encourage head turn away from the flattened side.
Because tummy time relieves pressure from the back of a baby’s head, it is an excellent position to prevent head flattening. This is also a great position for strengthening the head and neck muscles. The muscles that extend the neck and keep the head up against gravity are attached at the base of the skull at the back. When a baby is on its tummy, these muscles are contracting and working hard to keep the head up. The pull of these muscles on the lower skull, can help to round out the lower part of the back of the head (occipital area). Tummy time should always be supervised.
Most of a child’s skull growth occurs during infancy. Skull growth slows and the skull hardens during the toddler years. Early prevention and treatment are therefore important. After a child reaches one year of age, the window for treatment quickly closes.
Cranial Osteopathy may be helpful if Plagiocephaly is detected before 12 weeks old. After this time there is very little benefit. A Cranial Osteopath will check the position of the baby’s skull alignment with the neck and will evaluate the tension in the neck muscles. The sooner the baby is diagnosed and preventive measures started, the better the outcome for baby. Cranial Osteopathy combined with the above preventive measures is the treatment of choice for babies under 12 weeks old.
If the head flattening persists and is severe enough, babies can be treated with a helmet (cranial molding orthosis) to help guide future skull formation. The helmet is non-invasive and works by applying a gentle constant pressure over the areas of your baby’s skull which are most prominent while allowing unrestricted growth over the flattened areas. It is a pain-free treatment. The band consists of a soft foam layer inside a thermoplastic shell. This allows for frequent adjustments during growth and gently guides your baby’s skull into a more symmetrical shape. The helmet allows your baby to sleep in any position he/she wants by keeping the pressure off of the flattened areas.
If you would like more information on Plagiocephaly, Re-positioning and Tummy Time please contact us and we will email you some fact sheets.
Frank Kelleher, Cranial Osteopath
The Children’s Clinic, Cork.
Tel; 021 4348918