Plagiocephaly – The Flat Head Trend

Okay ,so maybe trend is the wrong word…trend to me implies something cool or something we want, plagiocephaly or flat head syndrome, however, not so much.

What is plagiocephaly?

Plagiocephaly is the asymmetrical flattening of the head, either at birth or just after birth.  Typically it is a flat spot on one side of the back of the head, with forehead, ear and face changes in severe cases (looking like a parallelogram from the top).  Less often, it is a flat spot at the centre back of the head, called brachycephaly, which causes a widening of the head and can elongate the top of the back of the skull.

Plagiocephaly can occur with or without torticollis. Congenital musclular torticollis, as it is called in infants, is a shortening of the sternocleidomastoid muscle in the neck, which results in the head being tilted and rotated to the side, leading to a flat spot on the back of the head. When there is no torticollis present, it is called positional plagiocephaly since it is as a result of positioning.

Whew…that is a lot of medical terms, let’s move on!

Research has uncovered some predisposing factors both during the gestation period and after birth. During the gestation period, obviously, the less space a baby has, the higher the odds are that a positional deformity can start.  Males, multiples, babies with large gestational size, first borns and breech position are all risk factors.  Once the baby is born, factors increasing the risk include limited tummy time, lower activity level, exclusive bottle feeding and sleeping on the back.

BUT wait!!!!  Aren’t babies supposed to sleep on their backs?!

YES!  But this is the same reason plagiocephaly is on the rise.  Over the last 24 years, since the Safe to Sleep initiative started (formerly Back to Sleep), in an effort to decrease Sudden Infant Death Syndrome, plagiocephaly has seen a dramatic rise.  Studies, the most recent from 2013, are now placing the incidence of plagiocephaly at approximately 48% of 7 week – 4 month olds.  I would argue that it has probably increased again over the last 5 years with the increase of container babies. (You may be reading that and thinking WHAT?!? Stay tuned to a future article about container babies!)

What can we do about it?

There are a variety of things you can do to help prevent and improve plagiocephaly, including positioning suggestions, tummy time and using a Mimos Pillow.  In severe cases a helmet therapy may be recommended.

The Mimos pillow is a pillow that is designed to spread out the amount of contact the head has on the pillow. This means that rather than have one condensed area of pressure it distributes it which can help prevent plagiocephaly.  If the flat spot is already present, the use of the pillow, in conjuction with physiotherapy, can help correct the head shape.  It is a class 1 medical device (meaning is safe to use), so no need to worry.  Check out Mimos Pillow for further information.

Why wait and see isn’t a good plan

I occasionally hear parents say they got told to wait and see and that it will improve – in very mild cases that may happen.  However, timeliness can be important!  Typically, we see the most change within the first 6 months after birth and, should helmet therapy be needed, you want to get started ASAP.  Once the skull fuses, there is little change to the shape.

If your child is one of the many that has plagiocephaly, I encourage you to reach out to your pediatric physiotherapist to assess for torticollis, take measurements to monitor the progress, give you positioning suggestions and measure you for a Mimos pillow (they sometimes even have discount codes available)!

Should you have any further questions feel free to contact me!

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