What are Plagiocephaly and Brachycephaly?
Plagiocephaly and Brachycephaly are medical terms given to the condition of flatness in the shape of the head.
Plagiocephaly is the name for flattening of the head in any of the four quadrants of the cranium (back, front, left, right). It is this condition that often results in asymmetry of the head and face as the ear, forehead and cheekbone on the flattened side of the head are pushed forward.
In Brachycephaly either the front or the back of the head lacks projection. This condition is not usually characterized by asymmetry of the ears and facial bones.
What causes a misshapen head?
The following may be causes of an improper development of the head shape among infants:
- Prolonged lying on the back;
- Torticollis;
- Misalignment of the body;
- Delivery at birth;
Misshapen heads have become markedly more common, since the introduction of the Back To Sleep Program designed to prevent Sudden Infant Death Syndrome (SIDS). There has been a 40% decrease in SIDS since mothers have been taught to put their babies down to sleep on their backs rather than their stomachs. Unfortunately, however, prolonged lying on the back is one of the causes of children developing a misshapen head.
Torticollis is a condition in which spasms in the neck prevent the baby from turning his head equally in both directions. It may cause a child to favor looking either to the left or to the right. Torticollis should be corrected as soon as possible or the face and head of a child may not develop symmetrically. It is advisable to seek the assistance of a trained practitioner as early as possible for early assessment and prompt treatment.
There are a variety of causes misalignment of the body in infants. Common causes are relatively large babies born from a small maternal pelvis, or multiple infants (twins) leading to crowding in the womb. In the case of twins, one twin may be more compressed than the other in the womb. Sometimes a baby’s head may become stuck in its mother’s pelvis or under her ribs, restricting the infant’s movement. In one case that I assessed it was possible to see where the maternal ribs had pressed into the top of the baby’s head. When a baby’s pelvis is misaligned, the position of the head and neck will also be affected.
Given the softness of an infant’s bones, difficult or assisted deliveries may alter the alignment of a baby’s head and facial bones, particularly when instruments such as ventouse or forceps are used. Forceps can leave an impression on the bones of the head, and ventouse can cause elongation of the head. Sometimes misalignment will correct itself although this depends on the amount of force that had to be used in delivering the baby safely.
Misconceptions:
Mothers often assume that baby’s condition is somehow their fault, wrongly believing the way they hold their baby or wash his hair is responsible. This is certainly not the case.
Neither is the condition hereditary. In fact, it can actually result from a perfectly normal delivery. For example, one eye can be smaller and higher on the face; this is actually a facial slant caused by the facial bones dragging along the mother’s tail bone. Just how prominent the facial slant is depends on the size of the head, the size of the mother’s pelvis and the position of her tailbones. Around 70% of facial slants occur on the left side, as most natural deliveries lead with this side. Often the bone on the back of head will also rotate, causing a less rounded skull.
Prevention
Crying & Sucking
Crying and sucking both help to shape a baby’s head by contracting the connective tissue. If using a bottle to feed baby, make him work harder by using a slow flow teat.
Check Your Baby’s Alignment
Get a professional to check out your baby’s alignment a few weeks after the birth when the body and head have had a chance to stretch out and reshape. If this does not happen, have someone trained in working with infants check and treat any misalignment of the pelvis, spine or head. If you had a c-section with no complications and the head shape was perfect when your baby was born, arrange to see a therapist trained in head shaping if it suddenly starts to become flat.
Tummy Time
All babies should have tummy time six times a day. This should be for as long as they can tolerate it, even if it is only for 30 seconds. This not only takes pressure off the back of the head, but also strengthens the neck muscles to help with reshaping the head. Many of the neck muscles are attached to the sides of the face and skull.
Head Brace/Helmet
Head braces or helmets may be considered for children who have not had their misshapen head condition corrected during early infancy, when the condition is more easily and more effectively treated. Head braces or helmets are not fitted on children of less than eight months of age. The helmet is worn for about 9-12 months, 23 hours a day, and requires adjustments every six weeks or so.
Other Tips
- Alternate sleeping positions from back to side, to the other side.
- Do not let your baby stay in a car seat or stroller for long periods of time.
- If you bottle feed, alternate the sides on which you hold your baby.
When should I seek help?
Of course you are concerned about your child, so be proactive and seek help. A child does not outgrow the misshapen head condition, although it may improve slightly with time. When a child grows hair it is less noticeable, but the problem is still there, so the sooner you seek treatment, the better.
An infant has seven soft spots in his head, and there is a lot of movement between the skull bones. The first one starts to fuse after two months; this is the forehead, which is in two pieces in a baby. I have seen many children come in for head shaping between the ages of nine months and 30 months when it is already too late to achieve significant change. Some valid work can still be done at this age, but it can also be time consuming with a toddler who cannot lie still, so the treatment takes longer. The earlier you seek treatment, the more effective it will be.
