Plagiocephaly is also known as flattened head or positional deformational plagiocephaly (to be distinguished from caused by premature fusion of skull sutures). This is caused because babies spend more time on their backs, which then results in pressure on the back of the head. Since the early 1990s, the American Academy of Pediatrics encouraged parents to position babies on their backs while sleeping in an effort to reduce Sudden Infant Death Syndrome (SIDS). This resulted in a 40% decrease in the incidence of SIDS in the United States. Add this to the trend of using a baby carrier for a car seat and traveling in everyday errands sets up a combination of daytime and nighttime pressure to the back of the baby’s head.
Caregivers and parents should continue to have their babies sleep on their back. When awake, the baby should be repositioned and placed on his or her tummy to relieve the pressure on the back of the head. This will also help strengthen the baby’s neck and torso muscles. Tummy Time will allow your baby to develop the ability for rolling over, sitting, walking, and standing.
What Are the Causes and Risk Factors for Plagiocephaly?
There are several risk factors that lead to plagiocephaly in the newborn infant. Premature babies or low birth weight can lead to plagiocephaly. Typically these infants spend a month or two in the neonatal intensive care unit (NICU) laying on their back. We also see plagiocephaly more often in twins and triplets. This is likely due to restricted space in-utero during the pregnancy and then prematurity along with low birthweight requiring a stay in the NICU after birth. Some babies are also excellent sleepers at night which can also lead to more flatness on the back of the head.
What Is Torticollis and Head Tilt/Neck Twist?
Occasionally a baby experiences head tilt to one side or the other, called torticollis. This condition can develop due to three primary causes: postural issues, muscle tightness or deformity, or a neck muscle mass (benign tumor of the muscle on the side of the neck).
Postural torticollis does not involve tightness of the sternocleidomastoid muscle or the presence of a mass. Postural torticollis can be a type of congenital muscular torticollis, and it typically resolves on its own without surgical treatment. The best approach is often to incorporate some physical therapy, particularly stretches, and routinely assess the child’s progress. It’s important to treat postural torticollis early in life, so that more serious and potentially irreversible conditions do not occur.
Muscle tightness can also cause torticollis. Infants can develop tightening of the neck muscles on one side, causing the baby to only look to one side. The sternocleidomastoid muscle becomes shortened on one side, causing the chin to point up and towards the opposite side. The shoulder is often higher on the affected side. This is also called congenital muscular torticollis and can be treated with muscle stretching exercises. Typically, physical therapy can resolve the tightness over time. Torticollis can also cause deformational plagiocephaly, so treatment of the muscle tightening is an important step in improving the head shape.
If during the physical evaluation a neck or sternocleidomastoid mass is discovered and determined to be the cause of the torticollis, treatment will depend on the size of the tumor, the complexity of the condition, the type of mass, and other factors. Most neck masses are one of three types: developmental, inflammatory/reactive, or neoplastic. A biopsy and lab work are often the first steps to developing an effective treatment plan.
Treating Plagiocephaly: Tummy Time Tips
- Supervised activity with your baby positioning on his or her tummy.
- Play with your baby encouraging head movement with favorite toys to look at and grab.
- Carry your baby on his or her belly.
Other Helpful Positions to Treat Plagiocephaly
- Alternate positions of your baby on the changing table.
- Roll your baby from side to side.
- Talk to your baby from different sides since this will cause them to turn their head.
- Place your baby over a small roll to support the baby’s upper body.
- Carry your baby facing away from you with your arm supporting under the chest. This is done after your baby develops neck muscle strength.
- Sit with your back supported and knees bent with your baby positioned against your legs facing you for feedings.
- Change the arm you use to hold your baby while feeding.
- Minimize the time your baby spends in infant carriers, car seats, and high chairs.
If repositioning your baby does not improve the head shape, a helmet can be a possible solution. Typically this is only an option if after a trial of tummy time does not improve the head shape and the shape is severe. The helmet is worn for about 23 hours a day and removed only for bathing.