| Plagiocephaly is a condition in which the head of an infant becomes mishapened, usually becomes of flattening of one side of the back of the head (posterior plagiocephaly). It is easiest to see the flattening by looking down on the top of your child's head. In addition to having a flat head, you may also be able to see that his ears don't line up.
Although rarely associated with craniosynostosis, or a premature closing of the lambdoid sutures of the skull, it is most commonly caused by the position in which the baby spends the most of his time. Recently, the AAP recommendation that all newborns and infants sleep on their back has probably lead to the rise in cases in recent years. The Back To Sleep program has lead to a large decrease in the number of children that die from Sudden Infant Death Syndrome (SIDS), so it is recommended that parents continue to place their infants to sleep on their back, but it is best to vary the position that they sleep in to prevent flattening.
It is important that your child with a flat head be examined by his Pediatrician to make sure that he doesn't have craniosynostosis, a rare, but more serious condition that usually requires surgery to correct. Your doctor can usually tell by examining your child if the flat head is caused by positional plagiocephaly or by closure of a suture. Some clues on examination that would favor a diagnosis of a positional deformity include that your child's ear on that side of his head will be displaced away from the area of flattening. Children with posterior flattening caused by craniosynostosis will have the ear displaced toward the area of flattening. Also, with positional flattening, the forehead will be prominent or have bossing (meaning it will be bulging outwards) on the same side of the skull that is flattened in the back. If the diagnosis is uncertain, then your doctor may order skull x-rays or a CT scan or MRI to check and see if the sutures are still open.
Children with positional plagiocephaly are usually first treated with recommendations to keep them from lying on the flattened side of their head. Sometimes moving his crib so that it is facing another direction, or moving his toys or mobile will encourage him to turn his head. You should also try and keep him on his stomach for 'tummy time' during the day when he is supervised.
Mild deformities will usually correct on their own with these measures. If there is no improvement in a few months, then children with positional plagiocephaly may need to treatment with a molding helmet or head band, such as the Dynamic Orthotic Cranioplasty Band (DOC band) that can help to reshape the head. These devices are worn for most of the day to mold the skull's shape back to normal. The DOC band and molding helmets work best if used during your child's first year of life. For more information on the DOC band, please visit the manufacture's web site, Cranial Technologies, where they have before and after pictures, a frequently asked question list and a list of clinics that are using the DOC band.
Some children with congenital torticollis, a condition in which the muscles of one side of the neck are tight and keep the head turned to that side, are prone to get a flat head. In addition to the treatments described above, they may also benefit from physical therapy. Premature babies are also more prone to getting a flat head from positional molding of their skull.
It is important to remember that having a flat head caused by a positional deformity is a cosmetic problem, and the brain continues to grow normally. Your child will not have any disabilities from this condition and if treatment is begun early, usually before six months of age, the results will be very good, with a normal or near-normal head shape.
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