Plagiocephaly

Brief Information

Introduction

This is a disorder that affects the skull, making the back or side of your baby’s head appear flattened. It is sometimes called 'deformational plagiocephaly' or 'flat head syndrome'.

The skull is made up of several bone plates which, when we are born, are not tightly joined together. As we grow older, they gradually fuse - or stick - together. When we are young, they are soft enough to be moulded, and this means their shape can be altered by pressure on it to give part - usually the back - of a baby’s head a flattened look.

Although you may hear plagiocephaly referred to as a type of craniosynostosis (a condition where the skull plates do fuse too early), the skull plates are not fused, but moulded into a different shape - a condition that does not require surgical treatment.

Causes

A baby's skull is very soft and can be forced to grow in different directions fairly easily. When the skull is kept in one particular position for long periods - because the baby is sleeping in a set position (such as on his back) or because muscles attached to the skull go into spasm (known as torticollis) - areas of the skull may be squashed or pulled flat. This is known as positional or deformation plagiocephaly.

Plagiocephaly may also be caused by the bones of the skull joining together abnormally early. These bones normally grow together slowly so the skull expands in all directions. But if some fuse too soon (craniosynostosis), that part of the skull can't grow in the way it should, pulling the head out of shape.

Other factors that increase the risk of plagiocephaly include a multiple birth pregnancy (as the babies 'squash together' in the womb), prematurity, poor muscle tone and a condition known as oligohydramnios, where there's insufficient fluid in the womb to cushion the baby.

Treatment

Initially at least, the same technique is used to treat most cases of positional plagiocephaly as to prevent it. By keeping your baby off the part of the head that has flattened, growth should even out.

It will take some time to see improvements - usually six to eight weeks. If your baby doesn't improve or gets worse, an expert needs to check for other causes. A specialist may recommend a skull-moulding helmet or band is worn.

If your child has torticollis (spasm of the neck muscles), treatment may include physiotherapy and neck exercises to increase movement of the head and neck.

If plagiocephaly has resulted from premature fusion of the skull bones, an operation is almost always required to unlock and move the bones. Long-term complications include asymmetry of the face (in about ten per cent of cases) and persistent flattening (in as many as one in three cases). It can also be linked to developmental delay.

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