Pediatric Plagiocephaly

What is Pediatric Plagiocephaly?

Pediatric plagiocephaly refers to the asymmetrical or flattened shape of a baby's head. It can occur due to various factors, including positioning in the womb, tight muscles, or external pressure on the soft skull bones. This can sometimes be confused with craniosynostosis as both can impact the shape of the head, however the cause and treatment of each of these are very different.

How are plagiocephaly and craniosynostosis different?

While plagiocephaly and craniosynostosis can both contribute to differences in a baby’s head shape, they are otherwise very different processes. Craniosynostosis represents an internal problem with the growth centers of the skull and can impact the development of the underlying brain and may require surgery. Plagiocephaly, on the other hand, represents a problem with external pressure on the skull. It does not impact brain development or require surgery.

What Causes Pediatric Plagiocephaly?

The most common cause of pediatric plagiocephaly is positional, resulting from prolonged pressure on one part of the baby's head. In young children the skull is rapidly growing and expanding to accommodate the growing brain inside. If there is consistent external pressure on a portion of the skull, this can limit the growth in this area and cause overgrowth in other areas. This can occur due to the baby consistently sleeping or resting in the same position. Other factors, such as muscle tightness or torticollis, can contribute to the development of plagiocephaly.

How is Plagiocephaly Diagnosed?

Plagiocephaly is typically diagnosed through a physical examination by a craniofacial surgeon. The healthcare provider will assess the shape of your child's head, evaluate any associated symptoms, and inquire about their positioning and movement habits. In some cases, imaging tests, such as CT scans, may be recommended to rule out craniosynostosis or assess the severity of the condition.

Can Plagiocephaly Resolve on Its Own?

In many cases, positional plagiocephaly can improve or resolve on its own with simple interventions. As babies grow and develop, their skull bones become less malleable, and they spend more time upright, reducing the pressure on the affected area. However, if the condition does not improve or worsens over time, further evaluation and intervention may be necessary.

What are the Treatment Options for Plagiocephaly?

The treatment approach for plagiocephaly depends on several factors, including the severity of the condition, the presence of associated symptoms, and the age of the child. The first line of treatment is behavioral changes and other common treatment options include:

Repositioning Techniques: Simple repositioning techniques, such as changing the baby's head position during sleep, while supine during the day, and when feeding can help to offload pressure from the affected area of the skull.
Minimizing supine time: Reducing the amount of time children spend on their back during the day in order to offload pressure from the affected area. This includes minimizing times spent in a reclined position such as in baby swings and bouncers.
Maximizing tummy time: One of the most important things you can do for a child with plagiocephaly is to work to increase their tummy time. This benefits them not only by offloading pressure from the back of the head but by encouraging development of the muscles of their neck and back which is beneficial not just for head shape but also for overall motor development.
Physical Therapy: If muscle tightness or torticollis contributes to plagiocephaly, physical therapy exercises may be recommended to stretch and strengthen the affected muscles.
Helmet Therapy: In some cases, when repositioning and physical therapy do not yield significant improvement, a custom-fitted helmet or cranial orthosis may be prescribed. These helmets help redistribute pressure on the baby's skull and promote symmetrical growth.

When Should I Seek Treatment for Plagiocephaly?

It is generally recommended to seek early evaluation and intervention for plagiocephaly. Because the child’s head growth is the fastest during the first 9 months of life, the earlier the condition is addressed, the more effective the treatment options can be. It is ideally recommended to be evaluated by a specialist by 4 months of age and if diagnosis is made later to be seen as soon as possible. Generally prolonged observation beyond 4 months is unlikely to result in spontaneous improvement and referral to a specialist is warranted.

What Can I Expect During Treatment?

The treatment process for plagiocephaly varies depending on the chosen interventions. Repositioning techniques and physical therapy may require regular follow-up visits to monitor progress and make adjustments as needed. If your child requires helmet therapy, the initial fitting and subsequent adjustments will be done by a orthotic specialist. The duration of helmet therapy can vary but usually ranges from 2-4 months.

Are There any Potential Complications or Risks?

In general, the interventions for plagiocephaly are safe and well-tolerated. Repositioning techniques and physical therapy carry minimal risks. Helmet therapy may have some temporary side effects, such as skin irritation or sweating. However, serious complications are rare, and the benefits of intervention often outweigh the risks.

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