A newborn’s skull is  very soft and pliable with fibrous membranes called fontanels between the skull bones.  These characteristics of the newborn skull allow for passage through the birth canal and rapid growth of the brain during the first years of life.  When all goes well, the skull enlarges as the brain grows and the fontanels close at the appropriate age.  However, because the skull is pliable it is susceptible to the pressures exerted on it. An infant’s skull will develop according to the forces placed on the skull and too much pressure in one area might lead to a misshapen head.

Misshapen heads can occur from the pressures exerted on the baby’s skull during labor and deliver, as well as forces that occur after birth. Since the implementation of “Back to Sleep” in the 1990’s the prevalence of plagiocephaly and misshapen heads has increased (*note: placing baby on his/her back to sleep is very important to reduce the risk of SIDS). There are a number of different shapes a newborn’s skull can take. Brachycephaly involves flattening of the entire back of the head, resulting in a wide head. Scaphocephaly describes a long, narrow skull and is more common in infants who spend extended time in the NICU or spend lots of time in the side-lying position. Plagiocephaly involves the flattening of the back and lateral part of the baby’s skull and is more common. Flattening on the right side of the skull is more common than the left side. Other terms include deformational plagiocephaly or flattened head syndrome.

There are a number of factors that can increase the risk of plagiocephaly. These include preterm birth, being part of a multiple birth, the use of forceps or vacuum during birth, and being male. After birth, factors that contribute to the development or worsening of plagiocephaly include:

• too little tummy time
• too little time spent upright and being held
• an increased amount of time in car seats, bouncy seats and other carriers that place baby on his/her back
• torticollis
• preference of the baby to turn his/her head to one side when sleeping

What can you do to decrease the chance of your baby developing plagiocephaly? Make sure baby is participating in tummy time, even for short periods of time, multiple times throughout the day. Also, alternate which direction you place baby in his/her crib and changing table so baby gets lots of practice looking in both directions to find you. Avoid excessive time in car seats and bouncy chairs, while providing lots of opportunities for cuddle time. Consider having mom and dad hold baby in different positions. If a baby’s plagiocephaly doesn’t improve with positioning, there are other treatment techniques such as helmets or bands that help reshape the skull.

The National Institute of Health has a good website that describes plagiocephaly. If you have questions about the skull shape of an infant you know, it is important to contact your pediatrician. It is recommended that an infant who has a misshapen skull past six weeks of age receive an evaluation by a pediatrician.

Our therapists at Beyond the Clinic can help families address any concerns related to plagiocephaly, as well as help families come up with ways to position baby and encourage tummy tine. We can help address risk factors and other conditions that may be present. Our home visits provide an excellent opportunity to work with baby and family in their home to address specific positioning concerns, while limiting the amount of travel for the entire family. Contact us at: (503) 496-0385 for more info!

Blog post courtesy of: Crystal Bridges, DPT