Plagiocephaly in Babies: What It Is and How to Avoid It

The baby's skull is born disarticulated in order to pass through the birth canal. This makes it prone to contouring and squashing, as occurs in the case of plagiocephaly in babies.

Plagiocephaly in babies is a deformation of the child’s skull, which is observed relatively frequently in the first months of life.

This is due, in large part, to the prevention of sudden infant death syndrome, which involves the custom of putting children on their backs. Although this measure has reduced the risk of fatal events in infants by 50%, it has also caused a considerable increase in plagiocephaly.

Do you want to know more about this condition? Keep reading.

What does plagiocephaly in babies refer to?

The term plagiocephaly means ‘oblique head’ and refers to a group of deformities of the baby’s skull. It’s also known as Flat Head Syndrome, as this is the appearance that the skull gives off to the naked eye.

Types of plagiocephaly

There are many ways to classify this condition. On this occasion, we’ll use one that distinguishes them according to the location of the problem and the appearance of the child’s head:

• Positional (or postural) plagiocephaly: The cause is external, usually due to lying on the back for several hours. The child’s skull becomes flat on the posterior or occipital side.
• Synostotic plagiocephaly: This type results from the premature closure of the joints of the bones of the skull. In general, this causes a main deformity and several compensatory deformities, so that the baby’s head appears quite peculiar and atypical.

The risk factors for plagiocephaly in babies

When babies are born, their skulls are disarticulated, which allows them to pass through the birth canal without problems. At birth, it’s normal for the bones of the head to be misplaced and even stacked one on top of the other. But this phenomenon is corrected naturally as the days go by.

Even so, there are some factors that can explain why a child’s skull may not mold adequately and be at a higher risk of developing plagiocephaly:

• Congenital torticollis
• A narrow uterine environment
• Premature birth
• Trauma during childbirth
• Strabismus
• Spending most of the day lying in the same position

Implications for the baby’s health

In general, plagiocephaly is of the positional or postural type. This causes a slight and localized deformity, which represents a mere cosmetic problem. With appropriate treatment measures, most babies return to their normal appearance within a few months.

In contrast, synostotic plagiocephaly involves an early closure of the sutures that join the bones of the baby’s skull. As a consequence, all the soft structures of the head cause other compensatory deformities in order to increase their size.

This condition limits the growth of essential organs such as the brain, which is why they usually require immediate surgical treatment.

How does the diagnosis of plagiocephaly take place?

A correct physical examination is sufficient in order to diagnose most cases of plagiocephaly. For a trained eye, it’s possible to differentiate the positional type from that which occurs due to premature closure of the sutures.

To correctly observe the child’s skull, you need to do it from above. In this way, it’s possible to observe the alignment that exists between the eyes, forehead, neck, and ears.

Complementary exams

When there are diagnostic doubts or when you suspect that the sutures are closing prematurely, it’s best to consult a specialist. A neurosurgeon is able to assess the situation of each child and determine whether or not to request studies.

Among the possible options, the doctor may consider certain imaging studies such as skull x-rays or CT scans.

Treatments for plagiocephaly

Many times, the success of treatment depends on when the diagnosis takes place. For this reason, it’s important that the pediatrician evaluate the growth of the child’s head at each check-up.

Conservative strategies

These include a series of non-surgical measures to modify the course of plagiocephaly:

• Baby Repositioning Techniques: Parents learn how to alternate the baby’s posture while sleeping and throughout the rest of the day. This is to prevent the head from always resting on the same point.
• Rehabilitation with physiotherapy: Especially to correct torticollis and other muscle problems that promote plagiocephaly.
• Cranial orthosis with helmets: This option is controversial, but it’s an effective alternative when the previous measures are insufficient

All of these strategies can be implemented from birth, but won’t be effective after one year. From that age on, the skull loses the ability to shape itself.

When is it necessary to resort to corrective surgery

Positional plagiocephaly usually goes away with the use of conservative strategies after 4 to 5 months. When this doesn’t happen or the deformity is severe, the specialist will consider surgical treatment.

In the case of synostotic plagiocephaly, surgery is the first treatment option.

How can I prevent plagiocephaly in babies?

The best strategy to avoiding the problem is to offer parents the necessary counseling during follow-up appointments with the pediatrician.

Below, we’ll describe some of the preventive recommendations from the Spanish Association of Pediatrics:

• When the baby isn’t sleeping, it’s best for them to lie on their tummy on a firm and isolated surface of the floor. Always under the supervision of an adult, in order to avoid accidents. This is known as tummy time and it serves several purposes. Experts recommend doing it for at least 1 hour a day.
• Alternate the position of the headboard of the bassinet or crib periodically. This prevents the baby from getting used to always turning their head to the same side.
• When using seats with tight spaces for the head (such as car seats), make sure that the baby can turn their head slightly and avoid spending a long time in the same position.
• Frequently picking up the child, holding, or carrying them. This helps to prevent the flattening of the head.

If your baby has a deformity in their head, don’t panic! It’s likely due to the position they usually adopt. Discuss this with your pediatrician at the next appointment.