Plagiocephaly

Plagiocephaly is 'a malformation of the head marked by an oblique slant to the main axis of the skull'. This condition is characterized by an asymmetrical distortion or flattening of one side of the skull. Positional or deformational plagiocephaly is known as 'flattened head syndrome' and this results from a preferential lying on one side of the head. Plagiocephaly is also common at birth, resulting from a restrictive intrauterine. The unusual head shape in plagiocephaly is caused by the pressure in the womb giving a diamond shaped head when observed from above. In some pronounced cases of plagiocephaly, there may occur flattening of one side of the chest as well.

Some other factors that increase the risk of plagiocephaly are multiple birth pregnancy where there is the risk of the babies squashing together in the womb. Prematurity, poor muscle tone and the Oligohydramnios condition with insufficient fluid in the womb to cushion the baby and torticollis or wryneck are other risk factors involved. In fact, nearly 15 to 25% of plagiocephalic children have torticollis. Frequent use of car seats, bouncy seats, infant swings are other contributory lifestyle factors to a baby where the back of head is flat.

Common symptoms of plagiocephaly or flat head syndrome include bald spot on the flattened side of an asymmetrical head, eyes appearing to have unequal positioning, flattening on one side of the back of the head with a compensatory bulge in the forehead on the same side, a parallelogram shaped head when viewed from above, where the back of the head is flat. Certain functional problems could occur at a later stage in life as a result of this deformity. These problems could involve vision, hearing, temporomandibular joint and developmental delay.

Treatment methodology advised by therapist to parents would include: to alternate the position or direction of the baby's head when sleeping, a tummy time of 15 minutes daily which will help take the pressure off the back of the skull, carrying the baby in a position that he/she can turn and look at both directions, dry the baby while the are on their tummy, allow infant to take supervised nap on the tummy for better head molding, avoid putting infants in a bouncy seat, car seat, sling or on a flat surface to dissuade constant pressure on one area of the skull.

However, it is imperative to distinguish between abnormal head shape caused by positioning and abnormal head shape caused by premature closure of cranial sutures, known as craniosynostosis. While positional deformation can be corrected without surgery, synostotic abnormal head shapes do require surgery. If left untreated, these children with moderate to severe plagiocephaly would experience other medical issues later in life.