FLAT HEAD SYNDROME

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 "WHEN A CHILD RECEIVES A HAIRCUT, THE SHAPE OF HIS HEAD BECOMES OBVIOUS"

Plagiocephaly, also known as flat head syndrome, is a condition characterized by an asymmetrical distortion (flattening of one side) of the skull. A mild and widespread form is characterized by a flat spot on the back or one side of the head caused by remaining in a supine position for prolonged periods.

The condition can cause the baby’s head to look asymmetrical. A baby’s skull bones don’t fully fuse and harden until several months after birth. Soft, pliable bones allow for easier passage through the birth canal and gives a baby’s brain ample room to grow.


TYPES

There are two types of plagiocephaly: Positional plagiocephaly and Congenital plagiocephaly.

Positional plagiocephaly, also called deformational plagiocephaly, is the most common type of flat head syndrome. Babies are most at risk of positional plagiocephaly in the first four months of life, before they have the ability to roll over by themselves. It affects up to 50% of babies. Positional plagiocephaly is more common in premature babies than full-term babies.



Congenital plagiocephaly, also known as craniosynostosis, is a rare birth defect. In babies with this condition, the fibrous spaces between the skull bones, known as sutures, prematurely close. This results in an abnormally shaped head. Congenital plagiocephaly occurs in one out of every 2,000 to2,500 births.


Positional plagiocephaly does not usually cause serious complications. If congenital plagiocephaly, which is caused by craniosynostosis, is left untreated, it can lead to serious complications, including:

·         Head deformities, possibly severe and permanent

·         Increased pressure inside the head

·         Seizures

·         Developmental delay


CAUSES

The most common cause of a flattened head is a baby's sleep position. Infants are on their backs for many hours every day, so the head sometimes flattens in one spot. This happens not only while they sleep, but also from being in infant car seats, carriers, strollers, swings, and bouncy seats.

Premature babies are more likely to have a flattened head. Their skulls are softer than those of full-term babies. They also spend a lot of time on their backs without being moved or picked up because of their medical needs, such as a stay in the neonatal intensive care unit (NICU).

 

Flat head syndrome can even start before birth if there's pressure on the baby's skull from the mother's pelvis or a twin. In fact, many babies from multiple births are born with heads that have some flat spots.

 

Flat head syndrome is caused by tight neck muscles that make it hard for babies to turn their heads. This neck condition is called torticollis. This is a condition in which an infant’s neck muscles are stiff or imbalanced. It’s often caused by limited space in the uterus or being in a breech position. Reduced space in the uterus or being in a breech position makes it harder for the baby to twist their neck and move their head. That can cause them to favor one side, which may lead to plagiocephaly or another skull deformity.

Forceps or a vacuum delivery: These instruments put pressure on the skull and its malleable bones, which could lead to plagiocephaly.



 
SIGNS AND SYMPTOMS

Flattened head syndrome usually is easy for parents (symptoms) to notice:

  • The back of the baby's head is flatter on one side.
  • The baby usually has less hair on that part of the head.
  • When looking down at the baby's head, the ear on the flattened side may look pushed forward.

In severe cases, the forehead might bulge on the side opposite from the flattening, and may look uneven. If torticollis is the cause, the neck, jaw, and face also might be uneven.

Signs to look for include:

  • A flattened area on the side or back of the head. Instead of being round, the head may appear slanted in a certain area.
  • Ears that aren’t even. A flattening of the head can cause the ears to appear misaligned.
  • A bald spot in one area of the head.
  • Bony ridges on the skull.
  • Lack of a soft spot (or fontanel) on the head

 


 

 

PREVENTION

  • Prevention methods include carrying the infant and giving the infant time to play on their stomach (tummy time), which may prevent the baby from progressing into moderate or severe plagiocephaly. Work up to a total of 40 to 60 minutes of tummy time per day.
  • Letting babies crawl may also prove to be crucial in preventing plagiocephaly as it strengthens babies' spine and neck muscles. Crawling also boosts gross and fine motor skills (large and refined movements), balance, hand-eye-coordination and overall strength
  • When you can, hold your baby upright instead of placing them in their crib, car seat, or baby swing.
  • Change feeding positions. For instance, if you bottle feed your baby while they’re nestled your right arm, switch to your left.

 


TREATMENT

Early interventions (based on the severity) are of importance to reduce the severity of the degree of the plagiocephaly. Diagnosis is most commonly determined through clinical examination.  In order to assess the severity of the condition and determine the best course of treatment, practitioners often use the Plagiocephaly Severity Scale.



 
The course of treatment is typically based on the age of the child when the diagnosis  is made in conjunction with the severity of the diagnosis. If a diagnosis of mild to moderate plagiocephaly occurs before four months of age, repositioning therapy may be helpful. If the diagnosis is determined to be severe, practitioners will likely prescribe a cranial molding orthosis (helmet), which has the best results when prescribed between five to six months of age.[12]

  • Counter-position therapy

It is important to always put the baby to sleep on their back to reduce the risk of SIDS, be mindful of changing their position.

For example, if the baby favors sleeping with their left cheek flat against the crib mattress, position their head so that they sleep on their right cheek.


  • Exercises

If the baby has muscular torticollis, then stretching exercises of sternocleidomastoid muscle (SCM) to increase the range of motion of their neck.

  • Molding helmet therapy

Molding helmet therapy involves having the baby wear a custom-molded helmet or band that will gently help reform the skull into a symmetrical shape.

According to the American Association of Neurological Surgeons, the optimum age of helmet therapy is 3 to 6 months. It can take about 12 weeks for the skull to be reshaped using this therapy. Molding helmet therapy is usually reserved for those with more moderate to severe cases of plagiocephaly.



  • Surgery

Surgery isn’t usually needed in cases of positional plagiocephaly. It’s needed in most cases of congenital plagiocephaly when sutures have closed and pressure in the skull needs to be released.

 

 

PROGNOSIS

Preliminary research indicates that some babies with plagiocephaly may comprise a high-risk group for developmental difficulties. Plagiocephaly is associated with motor and language developmental delays. While developmental delay is more commonplace among babies with plagiocephaly, it cannot be inferred that plagiocephaly is the cause of the delay.

 

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