Positional Plagiocephaly - Prevention

Positional Plagiocephaly is the most common positional head deformity and often presents with a parallelogram head shape when viewed from above. A positional head deformity is a condition that is caused by repeated external pressure applied to the same area of the skull. Due to the way in which the infant’s skull can mould during birthing, it is possible for repeated external pressure to cause the bones of the skull and face to shift, resulting in a head deformity and facial asymmetry.

• The most disturbing fact about Positional Plagiocephaly is that majority of cases are preventable.
• The truth is there are no steps that can be taken to prevent Positional Plagiocephaly from occurring in Utero.
• It is possible to prevent the majority of cases that develop after birth.
• Although we have been told time and again to keep babies on their backs to reduce SIDS, the one thing we were are not told is to change and vary the baby’s position so that the baby is not always resting on the back of the head.
• The number one preventative measure is to vary the sleeping position of the baby.
• Be aware of how the baby sleeps and take steps to make sure that equal time is spent on both sides of the head
• Before a child has the ability to roll, sleep positioners such as wedgers can be used to vary the baby’s position.
• Once it becomes difficult to dictate the baby’s sleep position, toys should be placed on both sides of the cot to discourage the child from always looking in one direction.
• When holding your baby in your arm, be sure to alternate arms to ensure that time is spent on both sides.
• If the baby is bottle fed, alternate the arms that you hold your baby with during feeding to ensure time spent on both sides
• Implement “Tummy Time” during play.
• Prevent the extended use of car seats (used as a carrier).

Being able to recognize the signs of Congenital Muscular Torticollis (CMT) is also important in prevention of Positional Plagiocephaly. If the baby tends to always turn in one direction or the head is always tilted to one side it is possible that Congenital Muscular Torticollis could be the cause. Although it is true that not every baby with CMT will have Positional Plagiocephaly, there is a high enough incidence rate of a baby having both disorders those parents should be able to recognize the warning signs and bring concerns up with the baby’s pediatrician.

Positional Plagiocephaly - Frequently Asked Questions

Please note that this information is not provided directly from a doctor and should never be used in the place of a doctor.  The goal in providing such information is to help other parents, family members and care givers of Plagio kids to understand what Positional Plagiocephaly is, what causes it, and finally how to prevent it.

What is Positional Plagiocephaly?

Many infants are born with abnormal head shapes, caused by circumstances in the birthing process; most abnormal heads will correct themselves within six weeks after birth.  Should this not correct itself, you need to determine the cause.  A correct diagnosis by a doctor or specialist is essential. 

• The diagnosis normally given is Positional Deformity of the head.

• The most common is Positional Plagiocephaly.

• Positional Plagiocephaly is caused when there is repeated external pressure applied to one side of the back of the head which then causes a flat spot.

• The side of the head that is flattened will often be accompanied by a prominent forehead, which when viewed from above will give the head a parallelogram shape instead of a normal symmetric oval shape.

It is also common for an infant with Positional Plagiocephaly to have misaligned ears - the ear on the effected side may be pulled forward and down - and facial asymmetry, with the affected side of the face having a fuller cheek, and a more prominent appearance. Facial asymmetry on the affected side can also include a jawbone that is tilted, and an eye that appears displaced and mismatched in size.

Why is it called Positional Plagio?

• The term Positional is used as this therefore differentiates from true Synostosis, which is the premature fusion of one or more of skull sutures (Craniosynostosis) and requires surgery to repair. 

• When the term Positional is used, it means that there is NO premature fusion of the sutures, it has actually been caused by external pressure on the skull and this has then caused the deformity. 

Types of Positional Head Deformities

Positional Plagiocephaly is not the only Positional Head Deformity, though it is by far the most common. 

Positional Brachycephaly is when the whole back of the head is flat and the head has the appearance of being wide and short.  Positional Brachycephaly is most often seen when a child sleeps entirely on the back of his head. 

Positional Scaphocephaly is when the head is long and narrow.  This is caused when the infant is in a breech position during the pregnancy and the head becomes wedged underneath the mother’s ribs.  Prematurity can also be a contributing factor to Positional Scaphocephaly.

Facial Asymmetry - What is this?

• External forces push the skull and cause deformity , this in turn can affect the features of the face. 

• Facial asymmetry is when one side of the face does not match up with the other side of the face. 

• Most often the affected side will have a more pronounced forehead and possibly a cheek that is fuller then the other cheek. 

• It is also possible to see the eye on the affected side appear displaced and mismatched in size and for the jaw to appear tilted. 

• All or some of these factors can make the face appear skew. 

Are the affects of Positional Plagiocephaly just cosmetic?

• Positional Plagiocephaly has been viewed as a purely cosmetic disorder as it is believed to not restrict brain growth or cause brain damage. 

• Other problems can arise, such as, problems with chewing and eating. 

• There is a possibility of experiencing problems with vision, this could become an issue and may require corrective surgery to repair. 

Should I suspect my child has Plagio who would I then consult?

• This would normally be assessed and diagnosed by a Paediatrician, you would then be referred to a Pediatric Neurologist, who would in turn refer you to a Craniofacial Plastic Surgeon. 

How would the diagnosis be confirmed?

• X-Rays, CT-Scans and MRI’s are normally performed to confirm the diagnosis. 

• Testing is normally done to confirm that the head deformity is not being caused by a true Synostosis. 

What causes Positional Plagiocephaly?

Inventro:  When a baby develops in a womb that is restricted, it can lead to Positional Plagiocephaly.  A baby that is in a breech position can also develop Positional Plagiocephaly if the baby’s head becomes wedged under the mother’s ribs. 

Prematurity:  The skull of a premature infant can be very soft making the head more susceptible to remolding due to external pressures.

Back Sleeping:  Parents are not given enough information regarding back sleeping and how an infant’s sleeping position should be alternated to prevent constant sleeping on the same side, parents are not informed of the importance of “tummy time” . 

What is Congenital Muscular Torticollis (CMT)

• Congenital Muscular Torticollis (CMT), which is also referred to as a Twisted Neck, is a condition that is usually caused when one or more of the neck muscles is shortened or tightened on one side. 

• This causes the baby’s head to tilt and/or to turn in one particular direction. 

• CMT can be very blatant or very subtle.  Parents are usually the first to notice the more subtle cases.

• If your baby tends to always look in one direction then it is very possible that CMT could be the cause.

• If you suspect that your child may have CMT it is important to have a doctor confirm this diagnosis

• Treatment of CMT usually consists of physical therapy to lengthen and loosen the affected muscle(s).

• In severe cases is surgery needed to repair the muscle(s).

Repositional Therapy

• Reposition therapy is simply the concept of repositioning the baby so that he does not rest on the flat spot.

• It is believed that by removing the external pressure, the flat area will correct itself as the head grows.

• Before trying reposition therapy it is important that the baby be cleared of Torticollis.

• If the baby has Torticollis it is important that parents discuss this with the baby’s physician and utilize physical therapy to stretch the neck muscles.

• If reposition therapy is to be used, the baby’s pediatrician should be consulted on the best way to achieve this. 

• Some common practices are placing a blanket or pillow against the flattened side to prevent the baby from rolling over. 

• Alternatively you can place the babies toys on the opposite side of the flattening in the cot to make the child look in that direction. 

• Adding "Tummy Time" can also assist in repositioning.   

Deformations (Positional Plagiocephaly)
An infant’s skull is made up of free-floating bones that are separated by sutures. The sutures, which act as expansion joints, allow the skull to mold for birthing and to expand with the rapidly growing brain.

While many infants are born with an abnormal head shape, due to the trip through the narrow birth canal, most will correct themselves within six weeks following the birth. When an abnormal head shape persists or is not noticed until after six weeks, it is important to determine the cause. A correct diagnosis is essential and should be made by a qualified specialist.

The diagnosis most often given is of a Positional Head Deformity. Due to the malleable nature of an infant’s skull, it is possible for external pressures to cause skull deformity. The most common Positional Head Deformity is Positional Plagiocephaly.

Positional Plagiocephaly is caused when repeated external pressure is applied to one side of the occiput (the back of the head) and a flat spot occurs. The side of the occiput that is flattened will often be accompanied by a prominent forehead, which when viewed from above will give the head a parallelogram shape instead of a normal symmetric oval shape.

It is also common for an infant with Positional Plagiocephaly to have misaligned ears (the ear on the effected side may be pulled forward and down and be larger then the unaffected ear) and facial asymmetry, with the affected side of the face having a fuller cheek, and a more prominent appearance. Facial asymmetry on the affected side can also include a jawbone that is tilted, and an eye that appears displaced and mismatched in size.