You’ve counted all of your newborn baby’s tiny toes and fingers, which are all perfect. And everyone says he is the spitting image of his handsome daddy – but a few months later, you notice that his head is noticeably flat on one side. New parents should be aware of a fairly common condition called positional plagiocephaly. Since infants’ skulls are soft, it is not uncommon to have a misshapen head related to the rigors of childbirth, but this usually resolves itself within six weeks of birth. However, some infants develop this condition within the first few months of life, caused primarily by sleeping on one side.
According to the American Association of Neurological Surgeons (AANS), the incidence of this condition has increased five-fold since the introduction in 1992 of the “Back to Sleep” campaign, which was launched to address the rise in sudden infant death syndrome (SIDS) cases. “While thousands of lives have been saved through this campaign, more babies have developed positional plagiocephaly, much to the concern of very worried parents,” stated Monica Wehby, MD, a pediatric neurosurgeon and AANS spokesperson.
“I see many babies with flattened heads and their parents are distressed that this is going to be a permanent condition and inevitably affect their child’s self esteem,” remarked Dr. Wehby. Fortunately, there are fairly simple treatment options to resolve this problem. “The most important first step is to bring your baby to his or her pediatrician when you first notice the problem, to receive a proper diagnosis, and obtain a referral to a specialist, if needed,” said Dr. Wehby.
Although the majority of cases of misshapen heads in babies can be attributed to positional plagiocepahly, a small number of infants are born with a far more serious form of plagiocephaly caused by craniosynostosis. In such cases, the deformity is caused by premature closure of the fibrous joints between the bones of the infant skull (called cranial sutures). A thorough examination is necessary to confirm or rule out this diagnosis.
Due to SIDS awareness, many infants now spend nearly 100 percent of the time on their backs. The risk of positional plagiocephaly can be reduced by simply alternating the sleeping position of the infant, adding supervised tummy time during play, and being aware of which direction the infant tends to look. The AANS offers these simple tips:
•Place the infant with his or head turned on the opposite side of the head. This can be achieved by placing a towel roll or rolled up blanket beneath the back and hip on the flattened side, positioning the baby to 45 degrees. Place interesting objects on the opposite side of the bed to attract the infant’s attention. Do NOT put the towel or blanket under the infant's head, because this can lead to suffocation. Many infants will wiggle off of the roll in a short time; some physicians recommend using Velcro or tape to secure the roll to the infant's body.
•When holding, feeding or carrying an infant, make sure that there is no undue pressure placed on the flat side of the head. Change infant’s head position from side to side during feeding time.
•Provide an infant with plenty of supervised play time on his or her tummy. This helps build and strengthen neck, shoulder and arm muscles.
•For optimal results, positional therapy should be started before the infant is 4 months old.
If positional therapy does not work, helmet or band therapy may be recommended. There have been many improvements in design since the introduction of the original molding helmet in 1979. The helmet/band is precisely fabricated and customized to your baby’s head to achieve improved symmetry and proportion. For optimal effectiveness, it is recommended that helmet or band therapy begin by 5 months of age. The length of therapy depends on the individual case, but usually takes between two and six months. The AANS offers the following guidance:
- Do not purchase helmets on your own without first consulting a physician specialist.
- When treatment starts at the optimum age of 3 to 6 months, it usually can be completed within 12 weeks.
- Correction is still possible in babies up to age 18 months, but will take longer.
- The baby will wear the helmet/band 23.5 hours per day with the exception of one-half hour set aside for bathing and cleaning.
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