Worried About Flat-Head Syndrome? What You Need to Know About Plagiocephaly
April 2016 marked annual World Plagiocephaly Awareness Day, and at Small Steps we know that many parents in our online community have concerns about possible Flat Head Syndrome – or Plagiocephaly – in your babies. So we asked Saeed Hamid, Plagiocephaly specialist at the London Orthotics Consultancy, to give us his advice on how to recognise possible signs of Plagiocephaly and what to do if you’re concerned about the shape of your baby’s head.
Recent research has shown that your baby will spend – on average – up to 700 hours on their back in the first couple of months of his or her life. This is also the period during which your child’s skull is at its most malleable. This is because the skull consists of plates of bone connected by fibrous joints known as ‘sutures’. These sutures are relatively soft in infancy and can, therefore, change shape.
Why does this matter? Constant pressure on a particular part of a baby’s head can lead to what is known as ‘positional Plagiocephaly’ or ‘flat head syndrome’. It may also involve bulging of the forehead, fullness of the cheek and ear misalignment on the same side as the flattening.
Multiple Causes for Flat Head Syndrome
There are, in fact, a whole host of factors that can lead to Plagiocephaly, including the baby’s position whilst in the womb – breech babies are more susceptible – the birth process itself or prolonged periods in a car seat or buggy, which tend to be firmer than old-fashioned prams. Meanwhile, some babies have a preferred sleeping position or they might have a condition known as Torticollis. In this instance, a tight or shortened muscle in one side of the neck causes it to tilt or turn to one side, leading an infant to repeatedly rest its head in the same position. In 2013, the London Orthotics Consultancy (LOC) analysed data from all of its first appointments at its clinic in Kingston-upon-Thames and found that 20% of the babies it examined had some kind of neck condition that was causing head immobility.
The number of babies developing Plagiocephaly has risen dramatically. A study involving 4,000 babies in the Netherlands in 1995 revealed that 9.9% had some form of Plagiocephaly at six months of age. Almost 20 years later, a Canadian study in 2013 found that 47% of 440 infants at a two-month well-child clinic had some form of Plagiocephaly. In the US, a nine-fold increase was reported between 1999 and 2007, with cases rising from three to 29 per 10,000 births in Texas.
One of the reasons for this rise is thought to be the phenomenally successful ‘Back to Sleep’ campaign, set up to encourage parents to place babies on their back – known as the supine position – while sleeping, in order to lower the risks of Sudden Infant Death Syndrome (SIDS). The number of infant deaths has halved as a consequence of the campaign and the advice remains that babies should always be placed on their back to sleep.
Taking Action to Address Plagiocephaly
So, what can be done? The NHS does not measure infant head shapes or recognise Plagiocephaly as a medical condition. And, as far as anyone knows, there are no long-term medical implications from the condition. However, clinicians at LOC regularly receive letters from adults with Plagiocephaly asking for help. Unfortunately, our skulls harden by the age of two and there is nothing that can be done to change the head’s shape after that.
The NHS has shifted its view somewhat, and today offers parents advice on ways in which you can reposition your baby’s head to help encourage natural correction where Plagiocephaly has occurred.
In most instances of Plagiocephaly this repositioning is the first place to start. The objective is to continually reposition your baby’s head so he or she is not resting on the existing flattened part. At night, you might consider alternating the end of the cot where your baby lays its head and you can turn his or her head for them.
The Importance of Tummy Time
Tummy time during the day is also crucial. A lot of babies don’t like lying on their stomach initially because they don’t have the strength to hold their head up. But stick with it – it will help them build strength in their neck and trunk muscles and also promotes invaluable progress towards crawling. If your baby needs a bit of help, you can start by using a support under their chest and make it fun by choosing interactive toys to play with or by lying down with them. You should also consider your baby’s head position while carrying, feeding and changing and try to minimise the amount of time they spend in car seats when not actually travelling.
Until around five months of age, repositioning and tummy time techniques can often be enough to encourage natural correction. For babies that have difficulty turning the head in one direction, physiotherapy can also be helpful.
Helmet Therapy: When and Why?
However, some babies simply do not get on with repositioning, making opportunities for natural correction harder to come by. In these instances, cranial remoulding therapy – using a helmet – can prove very effective.
A number of Orthotics Consultancies offer helmet therapy – in the case of LOC this is known as LOCBand. The technique uses a scanner to capture the shape of a baby’s head and reconstruct it into a 3D computer model, which is then used to build the helmet. It is a pain free treatment where by the helmet is specifically designed to guide growth of the baby's head and is adjusted regularly as the baby grows. It’s important to start this treatment early to have the most impact, and in a baby aged four to seven months the treatment usually last around three to six months.
In the first study of positional Plagiocephaly conducted on an Australian population, carried out between 2009 and 2012, it was found that the 84 babies (aged between six weeks and one year) who received helmet therapy saw a significantly greater reduction in asymmetry of head shape than the 87 who were not prescribed any therapy at all.
If you are concerned about your baby’s head and would like a fast, free opinion from one of LOC’s experienced clinicians, you can use the LOC flat head diagnosis form to upload photos of your baby’s head and contact details. An LOC clinician will respond within 24 hours.