Deformational Plagiocephaly (Flat Head Syndrome)
Plagiocephaly is a disorder that affects the skull in infants, making one side appear flattened. It is sometimes referred to as Flat Head Syndrome or Non-synostotic Deformational Plagiocephaly. The term derives from the Greek words plagios, meaning oblique or slanted and kephalikos, meaning head. In milder cases there is some flattening of the back of one side of the head (the occiput), but in more severe cases there may be an associated bulging of the forehead and the ears may not seem in alignment. The condition can include facial and neck asymmetry and often congenital muscular torticollis (a shortening of the Sterno-Cleido-Mastoid muscle on one side) is involved. The rate of incidence vary greatly depending on which article you read, spanning from 1 in 300 to 48 % of all live births. It does not appear to affect one race more than another and affects males and females almost equally with a ratio of 1.5 : 1. There is a higher incidence in premature babies, probably because the skull plates become stronger in the last few weeks of pregnancy. There are three main sub-categories which are normally grouped together: classic Plagiocephaly, Brachycephaly, in which there is a central occipital flattening and a parietal widening ( short, flat and wide head) and (more rarely) Dolicocephaly in which there is an elongation of the cranial vault causing a “narrow head” appearance.
The cause of the condition is largely thought to be sleeping position; babies spending too much time on their backs. In the past, parents were told to alternate sleeping position between back, right and left sides. However, in 1992 there was a big “Back to Sleep” campaign in order to minimise the incidence of Sudden Infant Death Syndrome (cot death). The campaign was very successful, resulting in a great decrease in infant mortality, but the downside was possibly a tendency to overcompensate and not allow the baby enough “tummy time” or time to roll around. Sometimes spontaneous movement may also be restricted in uterus in the case of twins and multiple births.
A baby’s skull is made up of many bone plates which are not fused together but separated by fibrous sutures and fontanelles (soft spots). During birth, the sutures and fontanelles allow the bones to slide over each other in order to decrease the head circumference and ease passage of the head through the birth canal. It also enables the head to grow rapidly in the first year of life, largely determined by the growth of the brain and reaches 90 % of adult head size by year 1 . After 24 months the bones have interlocked at the sutures. On rare occasions this fusion can occur prematurely, resulting in a condition called craniosynostosis.
Unfortunately, the condition is not just a matter of aesthetics. Cranio-facial asymmetry may be a factor in functional deficits involving vision, hearing, TMJ dysfunction and dental problems. Furthermore, Plagiocephaly has been linked to developmental delays in cognition, language and motor skills.
The treatment for Plagiocephaly varies according to the severity of the individual case. A good place to start is to begin an education program that will encourage front positioning and play, such as “Tummy Time”, using baby seats sparingly, placing toys at the baby’s side to attract attention and encourage side to side movement and to alternate left/ right sides for feeding and holding.
Chiropractors and osteopaths with post-graduate training in paediatrics can greatly help, firstly with a proper diagnosis of the condition and to determine if craniosynostosis is suspected, in which case further referral to a specialist paediatric unit will be needed, and secondly they can work on the torticollis (muscle tightening) and help with the remodelling of the skull through a series of very gentle movements. Only in the most severe cases will the baby need to be fitted with a cranial remolding orthosis, such as helmets or bands. The treatment regime for these devices is very rigorous, as they need to be worn 23 hours per day for up to six months.
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