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Positional Plagiocephaly


What is Positional Plagiocephaly (PP)? 

PP or,, flat head syndrome” is characterized by the development of a flat spot on the back or side of the head. An infant’s skull is very soft and prolonged pressure can cause a head deformity. PP does not have a significant effect on infant’s neurological development. Nevertheless, if left untreated it may progress to noticeable facial asymmetry, jaw misalignment and misshapen head into adulthood.

What causes PP?

The cause of PP is certainly multifactorial including womb position, size of the baby, possible breached orientation, limited space due to multiple births, prematurity, developmental delay, back sleeping without appropriate positioning or extensive use of carriers and bouncy seats. One of the most common conditions associated with PP is called Torticollis where tightness of specific neck muscles causes side preference which in many cases gradually lead to development of PP.

When PP usually develops?

Most parents notice the appearance of plagiocephaly features between 6-8 weeks of child’s age.

Why has PP become more common recently?

One of the many factors is preference of Back to Sleep program, which encourages parents to put infants to sleep on their backs. While this program prevents Sudden Infant Death Syndrome (or SIDS) markedly, there is a significant link between this practice and increased incidence of PP.

How can parents prevent or correct PP?

Initially, in cases of very mild PP supervised tummy time, correct handling and repositioning techniques should be sufficient in prevention and improvement of head deformity. However, in moderate or severe cases, multidisciplinary intervention will be necessary.

Will there be a need for a surgery?

It is very unlikely. This condition is treatable using non-surgical methods, such as positioning routine, handling techniques, specific stretching and strengthening exercises or in severe cases corrective devices like head bands. However, parents need to remember that time is not their friend and treatment should start as soon as PP or abnormal side preference is noted.

References:

  • Losee JE, Mason AC, Dudas J, Hua LB, Mooney MP. Nonsynostotic occipital plagiocephaly: factors impacting onset, treatment, and outcomes. Plast Reconstr 2007;119:1866-1873.
  • Plank LH, Giavedoni B, Lombardo JR, Geil MD, Reisner A. Comparison of infant haed shape changes in deformational plagiocephaly following treatment with a cranial remolding orthosis using a noninvasive laser shape digitizer. J Craniofac Surg. 2006;17(6):1084-1091.
  • Rekate H. Occipital plagiocephaly: a critical review of the literature. J Neurosurg. 1998;89(1):24-30.
  • Steinbok P, Lam D, Ginsh S, et al. Long-term outcome of infants with positional occipital plagiocephaly. Childs Nerv Syst. 2007;23:1275-1283.
  • van Vlimmeren LA, van der Graaf Y, Boere-Boonekamp MM, L’Hoir MP, Helders PJ, Engelbert RH. Risk factors for deformational plagiocephaly at birth and at 7 weeks of age: a prospective cohort study. 2007;119:408-418.

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