I am often asked about a condition called plagiocephaly which affects many babies and is a real concern for parents. Here are some of the questions that I am asked in clinic, which may be useful for parents who think their baby may have a ‘flat head’ also known as deformational plagiocephaly.
What is plagiocephaly?
Plagiocephaly is the name of a condition where the shape of a person’s head is flatter at the back. This is usually more so on one side and but can cause a significant asymmetry. This head shape can develop in the womb or during prolonged labour, but most commonly develops in the first 6 months of life. There are many conditions that can cause an abnormal head shape and each one will need a different treatment.
What causes plagiocephaly?
As the bones in babies heads are relatively soft in the first year of life, they can become flatter on one side, if they spend a lot of their time lying on their back. As babies start to become more mobile and are able to roll over on their own, this flatness will usually resolve on its own. Some babies have a preference for looking to one side, and these will tend to develop a flatness on the back of one side of the head.
Stiffness in the muscles of the neck called torticollis is one of the common causes of this, but there are other conditions such as anomalies of the spine which can also cause difficulties in turning the neck. Rarely, a squint (or ‘lazy eye’) can result in a preference for an asymmetric head posture which can also result in plagiocephaly. Craniosynostosis is a rare condition affecting a few babies which can cause an abnormal head shape in babies. A craniofacial surgeon will be able to help you distinguish this serious condition from the more common condition of positional plagiocephaly.
How do I know if my babies head shape is normal?
Most parents will be able to instinctively see if their child’s head is a normal shape. If you are concerned over your child’s head being asymmetric in any way and particularly if the condition is getting worse rather than better, then you should seek the advice of a paediatric plastic surgeon who specialises in Craniofacial conditions. In the majority of cases, this review will be able to diagnose positional plagiocephaly from craniosynostosis without any further investigations. Rarely an X-ray or CT scan will be required to make a diagnosis.
You can measure the size of your child’s head and plot this in your babies Red book in the charts in the section at the back. This will help your craniofacial surgeon see how the head is growing and will help at the appointment.
Can plagiocephaly cause brain damage?
No, it is not likely that positional plagiocephaly can cause brain damage. This condition is often worse in children who have a developmental delay, but it is not the cause of this delay.
Children with craniosynostosis have a risk of developing a condition where the pressure inside the head is increased. If this is not recognised at the right time, then there is a chance that they may have an injury to the brain from this being left untreated. If you have any concerns about developmental delay then you should request an opinion from a developmental paediatrician.
Can plagiocephaly be treated?
Although most children who have positional plagiocephaly will get better on their own, there are some, with conditions such as torticollis who will benefit from early intervention. There are very good treatments for torticollis which include exercises and in some children, surgery is beneficial. If your child has craniosynostosis, then a review by a paediatric plastic surgeon with expertise in craniofacial surgery will be required as early as possible to ensure that all treatment options are available to you and your child.
What about moulding helmets?
Moulding helmets are used to encourage a more rapid improvement in head shape with increased symmetry. As most patients with positional plagiocephaly will get better on their own, it is not clear whether moulding helmets do make a significant difference in the long term. It is more important for children with positional plagiocephaly to be assessed early for the causes of positional plagiocephaly so that the appropriate treatment can be carried out early. Your craniofacial surgeon can advise you on exercises that you can do with your baby at home and whether any further interventions such as moulding helmets would be useful or not.
Any interventions for positional plagiocephaly should ideally be carried out within the first 18 months of life to have the most effect. There may be some children who would benefit more from moulding helmet treatment and your craniofacial surgeon will be able to help you decide whether this would be beneficial for your child.
What should I bring to my appointment?
You should bring along your baby’s Red book so that the craniofacial surgeon can assess the growth charts at the back of the book. He will be particularly interested in the head circumference measurements. He will also be interested in your medical history, how the pregnancy and labour progressed as well as your child’s development.