Introduction:
Plagiocephaly is a condition in which the head is seen in a flat shape. When a baby is born, the bones are soft and are in a developmental stage. Therefore, much care is given while handling a newborn infant. Any misconduct can cause conditions like plagiocephaly, where one side of the skull gets flattened due to the repeated pressure exerted. This is also known as a flat head syndrome in babies.
What Is Plagiocephaly?
The human skull bone consists of several bone plates fused with a suture. During childbirth, the uppermost central part of the skull bone is not fused as the brain is still developing. Some of the major sutures of skull bone are coronal sutures present sideways of the head, the metopic sutures, the sagittal sutures, and the lambdoid sutures. When the baby is placed too long against a straight surface, it leads to the flattening of the skull bones. The front of the skull looks normal and gets flattened at the backside. The ear looks rotated. Plagiocephaly can also occur inside the mother's womb due to a restricted intrauterine environment.
It could also occur in twin pregnancy, premature delivery, or prolonged labor. In such cases, the baby is squeezed down the birth canal, which can even lead to tightening neck muscles in severe cases known as congenital muscular torticollis. It involves the right sternocleidomastoid muscle. Another common cause for plagiocephaly is laying the babies in the supine position, as this reduces the increased risk of sudden infant death syndrome (SIDS).
What Are the Signs and Symptoms of Plagiocephaly?
The most common signs and symptoms observed are:
-
Asymmetrical head shape.
-
The flattened back side of the head.
-
Flattened bones in the sideways.
-
Prominent forehead.
-
In synostosis cases, the baby’s skull bones do not close properly.
-
Inclination to one side of the head.
-
Difficulty in turning the head both sideways.
-
Finds it difficult to stay longer in the tummy position.
-
Abnormal positioning of the ears.
-
Delayed motor skills like rolling, crawling, etc.
How Can a Baby With Plagiocephaly Be Breastfeed?
Babies born with plagiocephaly have an asymmetric head. During lactation, mothers can lift the babies in their arms and feed their babies or use breast pump milk. Children born with plagiocephaly have difficulty lying down in the tummy position. Hence, this position should be avoided. Since the baby has more inclination to one side, the mothers should adjust their position accordingly, favoring the child’s position. This will help in better milk intake. The head of the child should be handled carefully, and the mother should hold the back of the neck while feeding the baby.
What Are the Different Types of Plagiocephaly?
Depending on the change of anatomical features, plagiocephaly is classified accordingly. Classification based on their head shape are:
-
Plagiocephaly: This looks like the asymmetrical shape of the skull bone.
-
Brachycephaly: It is seen as a flattened bone surface on the back of the skull. They are again classified into two types, synostotic, where one or more sutures are fused, and nonsynostotic, which is a skull deformation. Brachycephaly could be mild, moderate, or severe. In mild cases, the skull bone measures from ninety-one to ninety-three centimeters and has a cranial vault symmetry of five to nine millimeters.
-
Dolichocephaly or Scaphocephaly: It is seen as the elongation of the head shape.
Depending on the change of shape post-delivery, plagiocephaly is again classified as follows:
-
Positional or Deformational Plagiocephaly: It is a condition where there is a change in the shape of the skull due to prolonged stress caused by the positioning of the baby. It occurs in the first few months of infantile development. It is caused due to making the baby sleep in one position for long periods. This can be mild, moderate, or severe. Both mild and moderate cases do not require any treatment. As the child grows and decreases their sleeping time, all these positional deformities get auto-corrected. In severe cases, some children might require helmet therapy. This could also occur before birth due to a lack of amniotic fluid.
-
Right Lambdoid Craniosynostosis: This is a condition that is caused due to a rare genetic defect. The head looks like a diamond shape. It causes the skull bones to fuse prematurely. It affects the lambdoid suture, which is present at the back of the skull. In normal conditions, the lambdoid suture is formed between the parietal and occipital bone. Whereas in lambdoid craniosynostosis, these sutures are fused prematurely. The skull looks flattened when viewed from above.
What Is the Use of a Craniofacial Helmet or Band?
These are prosthetic devices used to correct the deformity of the craniofacial region, particularly plagiocephaly. The child should wear such helmets for about twenty-three hours daily to achieve effective treatment. Children who start the treatment early, at a younger age, achieve greater results. Before wearing a helmet, a scan of the head should be conducted to estimate the measurements. There are various types of helmets in the market, such as:
-
Copolymer: This is a kind of plastic. It is used in mild to moderate cases of brachycephaly.
-
Bivalved: It is used where tight contact needs to be made without causing head rotation. It promotes the side-to-side growth of the bones.
-
Side Opening: This comes with an easy side opening.
-
Surlyn: This is made of a clear transparent material. It is used in kids who had surgery previously and helps observe the wound healing process.
How Can Plagiocephaly Be Treated?
Babies born with certain congenital disabilities in the shape of their skull or caused due to prolonged positioning of heads for a longer duration can be physically managed by the use of prostheses as well as surgically managed. Mild to moderate cases get corrected in the coming years of their life. Such deformities are a natural part of life caused due to too much gravitational pressure exerted on one side.
-
Head Positioning: The baby's positioning could also be due to the acquired position that the baby followed in a mother's womb. When the baby is asleep, make sure no pillows are used. And when the baby is awake, it is better to carry the baby to shift the prolonged lying position. The baby can also be encouraged to tummy position at intervals of time.
-
Helmets: Using customized helmets helps the baby move their head sideways. It also allows guided growth in babies.
-
Surgery: In severe cases, pediatric plastic reconstructive surgeries are done to attain the proper anatomy of the head. This is done using resorbable plates and screws. For unicoronal craniosynostosis (a non-syndromic craniosynostosis that occurs when one of the two coronal sutures fuses before birth), minimally invasive endoscopic strip craniectomy (procedure during which a portion of the skull is permanently removed or replaced) is performed, followed by helmet therapy for about one and a half years. This procedure is carried out within six years of age.
Conclusion:
The infant's bone is very different from an adult's and is soft. This soft feature of bone allows the further development of the brain. The growth of the brain in babies occurs at a very exponential rate. Studies have shown that around seventy to eighty percent of infants born have mild plagiocephaly. To prevent such deformities, a pre-counseling of parents is done to educate them about the baby's positioning.
