Plagiocephaly

Lumiere Physical Therapy: What is Plagiocephaly?

Plagiocephaly, or “flat head syndrome” is a condition in infants that is more common than you think. In a study done in 2013 and published in Pediatrics, the incidence of plagiocephaly in infants 7-12 weeks old was 46.6%¹. That means that this condition affects ~1 in every 2 infants. Read below to learn more about this common diagnosis, the causes, and which medical professionals can help.

What is Plagiocephaly (Flat Head Syndrome)?

Plagiocephaly, also known as “flat head syndrome”, means that your child’s head has flattened due to the fact that your child’s skull sutures have not yet closed. This may be caused by an infant spending too much time on his back, especially looking only to one side, resulting in a flat spot on one side of the head. This also may be due to Torticollis, which involves a child only looking to one side due to muscular tightness in the neck/trunk/pelvis. If this is the case, it is important to begin to work on opposite head rotation as well as positioning, to help get your child off his back. A physical therapist can help with this. (Check out our previous blog post on torticollis which helps with specific exercises/positions.)

Once a flat spot develops, it will be more difficult for your child to look the other way due to the flattening, which further exacerbates the issue, creating a type of ridge on the back of your child’s head. There also can be facial asymmetries associated with the flattening. On the same side as the flattening, your child’s eye and cheek may be slightly larger, with a slight forward bossing on the same side of the forehead, and the same side ear may also be pushed forward. Facial asymmetries are typically corrected when the skull is properly aligned, which will depend on the severity of the head flattening.


What is Brachycephaly?

Additionally, your child may develop a flat spot on the entire back of the head (not just only one side), which is called Brachycephaly. This is also caused by an infant spending too much time on his back, or in equipment such as car seats or bouncers². A shaping helmet may be indicated for both plagiocephaly and brachycephaly, depending on your child’s age and the severity of the flattening, described below.



Who can I see about my child’s flat head?

If you’re concerned about your child’s head shape, first talk with your pediatrician. Your pediatrician may refer him to a plastic surgeon or an orthotist. A specialist can measure your child’s head shape manually or using a scan. Depending on the results, they may recommend a shaping helmet, physical therapy, or both. It will depend on your child’s age and the severity of the flattening. The ideal window of time to receive a shaping helmet is around 6 months of age, however a child can receive and wear a shaping helmet up to 12 months old. After 12 months of age, there is minimal benefit to wearing a helmet.



A few places you can go in the Chicago area:

  • Scheck and Siress

  • Transcend Orthotics

  • Dr. Frank Vicari at Advocate

  • Head Shape Evaluation Program at Lurie Children’s Hospital

  • Cranial Technologies



How long will my child wear a shaping helmet?

This will again depend on your child’s age and severity of the flatness. Your orthotist or plastic surgeon will decide based on your child’s progress with subsequent scans. Helmets are typically to be worn 23 hours a day, with two 30-minute breaks permitted. A child may wear a helmet for as long as in indicated to correct the head shape, which can be anywhere from 4-6 weeks on.


Will it make my child’s head harder to lift?

The shaping helmets are pretty lightweight. A child will not receive a shaping helmet until he has enough head control. There may be an adjustment period while your child gets used to wearing it, however some infants do not tend to notice.

How can a physical therapist help?

A physical therapist can help with the underlying muscular factors such as muscular tightness that causes your child to look one way (torticollis), or low muscle tone that makes it more difficult for your child to move around and transition to different positions. A physical therapist can help with strengthening your child’s muscles during tummy time, as well as help your child with positioning and exercises to teach your child to roll and sit on his own and tolerate more time on his tummy.


If you have any additional questions about your child’s head shape or alignment, you can call our office at Lumiere Children’s Therapy and speak with a physical therapist.






References:

  1. Mawji A, Vollman AR, Hatfield J,McNeil DA, Sauvé R. The Incidence of Positional Plagiocephaly: A Cohort Study. Pediatrics. 132 (2). August 2013.

  2. https://www.cranialtech.com/my-babys-head-shape/