What you need to know about 'flat heads' in babies

A clinical examination by your GP and/or paediatrician can diagnose plagiocephaly.
A clinical examination by your GP and/or paediatrician can diagnose plagiocephaly. Photo: Shutterstock

To clear up any confusion you may have heard about this condition affecting the head, we speak to Dr Catherine Jonas, Paediatric Respiratory and Sleep Medicine Physician at Westmead. Here is everything you need to know about plagiocephaly.

What is plagiocephaly?

Literally meaning 'oblique head', plagiocephaly is the term used to describe a baby with a flat or uneven head. Imagine a head that appears asymmetric, with the ear on the affected side often being pushed forward.

Before we delve into the details, know that plagiocephaly usually resolves - either by itself or with early intervention. In most cases, plagiocephaly does not affect the growth of a baby's head, or impact on their brain development.

What causes plagiocephaly?

There are several causes, the baby's position in the womb being one of them. By six weeks of age however, the head usually moulds to a normal shape.

'Positional plagiocephaly' can be caused by extended periods of play and sleep, due to constant pressure being placed on the skull if the baby's head remains in one position. This can also develop in a baby born with tight neck muscles or 'congenital torticollis', preventing them from turning their head to one side, and therefore placing ongoing pressure on the skull.

In rare cases, restricted space in the womb due to multiple births, breech position or a small maternal pelvis can predispose a baby to positional plagiocephaly, as can premature birth.

How is positional plagiocephaly different from craniosynostosis?

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While craniosynostosis also presents with an asymmetrical head shape, it results from the premature closure of one or more of the skull's fibrous joints, called sutures. The skull asymmetry of craniosynostosis is more severe than that of positional plagiocephaly, and it can cause progressive slowing in head growth.

Diagnosis of craniosynostosis is more complex than it is for plagiocephaly, requiring clinical examination, followed by skull X-rays and imaging scans.

How is plagiocephaly diagnosed?

A clinical examination by your GP and/or paediatrician can diagnose plagiocephaly. If they have any concerns, the paediatrician will refer to a craniofacial surgeon.

What is the treatment for plagiocephaly?

Here is a look at the several treatment options for plagiocephaly. The treatment selected will depend on the cause and severity of the condition.

Counter-positioning

Most effective between birth and four months, counter-positioning involves consistently repositioning your baby's head while they sleep to avoid pressure on the flat spot. It can also be helpful to put your child to sleep at alternate ends of the cot, and even change the position of the cot in the room.

Playtime

Play can be the perfect 'treatment time' for plagiocephaly, with supervised 'tummy time' from birth encouraging your baby to alternate head positions. This is worth practising several times a day, just for a few minutes to start; you can then gradually increase tummy time as your baby adjusts and begins to find it more comfortable. Alternating the side that you play with your baby from, and the side where you place their toys can also be helpful. Talking from different sides encourages head movements, and even though we all have one or two carrying positions we find most comfortable, it can be worth switching up the way you carrying your newborn.

Paediatric physiotherapy

This is required for babies with positional plagiocephaly due to torticollis.

Helmet Therapy

A custom-made, cranial modelling helmet is recommended for moderate to severe cases of plagiocephaly where counter-positioning has failed. For this you will need a referral to a Craniofacial Clinic in a children's hospital. Helmet therapy is most effective between four to eight months of age, and the helmet needs to be worn for 23 hours each day. To ensure optimal head growth and correction of the deformity, weekly or fortnightly adjustments are required. The average duration of helmet therapy is two to six months.

If the appearance of your baby's head doesn't look right to you, it's always best to eer on the side of caution and pay a visit to your GP or paediatrician. Early intervention is key for effective plagiocephaly treatment, and it is also important that other conditions, including craniosynostosis, are ruled out.

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