Plagiocephaly (Flat Head Syndrome): Symptoms, Causes, Treatment

What are the symptoms of plagiocephaly?

Plagiocephaly, often referred to as “flat head syndrome,” is a condition characterized by an asymmetrical head shape in infants. The symptoms of plagiocephaly can include:

1. Asymmetrical Head Shape: One side of the head appears flatter or more elongated compared to the other side. This is often most noticeable when viewed from above or from the side.
2. Uneven Forehead: The forehead may appear uneven, with one side protruding more than the other.
3. Asymmetrical Ears: The ears may be positioned differently on each side of the head. One ear might be pushed forward or appear lower than the other.
4. Facial Asymmetry: There may be noticeable differences in the alignment of facial features, such as the eyes or the cheeks.
5. Flattened Occiput: The back of the head may appear flatter, which is a common characteristic of plagiocephaly.
6. Head Tilt: The infant might tilt their head to one side consistently, which can contribute to the development of asymmetry.
7. Difficulty in Positioning: The baby may show a preference for turning their head to one side, which can exacerbate the asymmetry.
8. Uneven Neck Muscles: In some cases, there may be tightness or asymmetry in the neck muscles (torticollis), which can contribute to or result from plagiocephaly.

Plagiocephaly can develop in infants due to prolonged pressure on one side of the head, often from sleeping positions or spending extended periods lying on their back. Early detection and intervention are important for managing the condition. Treatment options can include repositioning techniques, physical therapy, or, in some cases, helmet therapy to help correct the head shape.

What are the causes of plagiocephaly?

Plagiocephaly, or the asymmetrical flattening of the head, can be caused by several factors. The primary causes include:

1. Positioning in the Crib: Spending prolonged periods lying on the back or one side can lead to flattening of the head on the side that is consistently in contact with the surface. This is particularly common with the “back to sleep” campaign designed to reduce the risk of sudden infant death syndrome (SIDS).
2. Torticollis: Congenital muscular torticollis, a condition where the neck muscles are tight or shortened on one side, can cause the infant to preferentially turn their head to one side, leading to asymmetrical head flattening.
3. Multiple Births: Twins or higher-order multiples may experience limited space in the womb, leading to abnormal head positioning and increased risk of plagiocephaly.
4. Premature Birth: Premature infants may have softer skulls and less muscle tone, making them more susceptible to developing plagiocephaly.
5. Uterine Constraints: Conditions such as intrauterine crowding or an abnormal position in the uterus can contribute to head flattening. For example, if the baby is positioned in a way that puts pressure on one side of the head, it can lead to asymmetry.
6. Extended Time in Car Seats or Bouncers: Prolonged use of car seats, bouncers, or other equipment that keeps the baby in a fixed position can contribute to the development of plagiocephaly.
7. Birth Trauma: In some cases, the shape of the baby’s head can be affected by trauma during delivery, especially if there was significant pressure on the head during the birth process.
8. Genetic Factors: While less common, genetic predispositions or congenital conditions affecting skull formation can contribute to plagiocephaly.

Preventive measures include varying the baby’s head position during sleep, providing supervised tummy time while awake, and adjusting the baby’s position in car seats and bouncers. If plagiocephaly is detected, early intervention and treatment can help address the condition and promote a more symmetrical head shape.

How is the diagnosis of plagiocephaly made?

The diagnosis of plagiocephaly is typically made through a combination of physical examination and, if needed, imaging studies. Here’s how the process usually unfolds:

1. Clinical Evaluation:

• Physical Examination: The healthcare provider will assess the infant’s head shape by observing and palpating (feeling) the head. They will look for asymmetry, flattening on one side, or other characteristic features of plagiocephaly.
• Measurement: Measurements of the head can be taken to quantify asymmetry. The provider may measure the head circumference and compare different parts of the head to assess the degree of flattening.

1. Assessment of Head Position and Movement:

• Head Position: Evaluating how the baby positions their head and any tendencies to tilt or turn in a particular direction. This can help identify associated conditions like torticollis.
• Facial Features: Checking for any facial asymmetry, such as uneven ears or facial features, which may be related to the head shape.

1. Imaging Studies:

• Ultrasound: In some cases, especially for very young infants, an ultrasound of the skull may be used to assess the shape of the skull and rule out other conditions.
• CT or MRI: For more detailed evaluation, especially if there are concerns about underlying conditions or if the diagnosis is unclear, a CT scan or MRI may be performed. These imaging studies provide detailed views of the skull and brain.

1. Differential Diagnosis:

• Ruling Out Other Conditions: The provider will consider other conditions that can cause similar symptoms, such as craniosynostosis (premature closure of skull sutures), to ensure an accurate diagnosis.

1. Referral to Specialists:

• Consultation: In some cases, especially if the condition is severe or if additional evaluation is needed, the healthcare provider may refer the infant to a specialist, such as a pediatric neurosurgeon or craniofacial specialist.

Diagnosis is typically straightforward when classic signs of plagiocephaly are present. However, thorough evaluation ensures that other potential conditions are not overlooked and helps guide appropriate treatment and management strategies.

What is the treatment for plagiocephaly?

Treatment for plagiocephaly focuses on correcting the head shape and addressing any underlying issues, such as torticollis. The approach depends on the severity of the condition and the age of the infant. Here are the common treatment options:

1. Repositioning Techniques:

• Tummy Time: Encouraging supervised tummy time while the baby is awake helps relieve pressure on the back of the head and promotes muscle development.
• Head Positioning: Alternating the baby’s head position during sleep and playtime can help prevent further flattening. This includes gently turning the baby’s head to the non-flattened side and varying their sleeping position.

1. Physical Therapy:

• Torticollis Treatment: If the infant has congenital muscular torticollis, physical therapy may be recommended to stretch and strengthen the neck muscles. This can help improve head movement and positioning.
• Exercises: Therapists may provide exercises to encourage symmetrical head movements and improve overall motor skills.

1. Helmet Therapy:

• Cranial Orthosis: For moderate to severe plagiocephaly, a custom-fitted helmet or cranial orthosis may be used. The helmet helps mold the baby’s head into a more symmetrical shape by applying gentle pressure to the flatter areas.
• Timing: Helmet therapy is most effective when started between 4 to 6 months of age, but it may be used up to 12 months or longer if needed.

1. Follow-Up and Monitoring:

• Regular Check-Ups: Frequent follow-up appointments with the healthcare provider or specialist are important to monitor progress and adjust treatment as needed.
• Assessment: Ongoing assessment of head shape and development helps ensure that the treatment plan is effective and that the infant’s head is growing in a more symmetrical manner.

1. Parent Education and Support:

• Guidance: Parents are given instructions on repositioning techniques, tummy time, and other strategies to manage plagiocephaly.
• Support: Providing information and support to help parents understand and implement the recommended treatments.

1. Surgical Intervention:

• Rare Cases: In very rare and severe cases where non-surgical treatments do not yield satisfactory results, surgical intervention may be considered. This is usually a last resort and involves reshaping the skull through surgery.

Early diagnosis and intervention are crucial for the best outcomes in treating plagiocephaly. Most cases can be managed effectively with conservative measures, and many infants experience significant improvement with appropriate treatment.