Plagiocephaly In Infants

Published: 14 May 2018

Plagiocephaly In Infants

There are few joys in life comparable to bringing home a new baby. However, this time of excitement is often accompanied by a sense of uncertainty, especially if this is your first time on the baby rollercoaster and you’re still unsure of what to expect.

Of course, there will be plenty of people along the way willing to offer some helpful (or not so helpful) advice of what toys are good for learning, general foods to avoid and how much time your baby should spend playing on their back verses their stomach.  However lovely the intent, this advice can snowball into a well of confusion that is often hard to navigate. What should my baby be doing? When are they supposed to crawl? Or sit? How should they play? Does it matter?

One key word to keep in mind with your new bub is this: Balance.

Head Shape and Plagiocephaly – Plagio What?

Plagiocephaly is a very common condition seen in newborn babies and refers to a flattening of part of the back of a baby’s head.
Positional plagiocephaly is more common in younger babies, with rates increasing from 6 weeks of age to a peak at 4 months. This is not an immediate cause of alarm as there is no research to suggest that this change in head shape has any impacts upon brain development.

However, if left unmanaged, can gradually cause changes in the baby’s head shape, ear positioning and fascial alignment.

How Does Their Head Shape Change?

When babies are first born, the bones of their skull are not yet fused together and are separated by sutures and fontanelles. These flexible junctions between bones allow the sutures and fontanelles to be narrowed and the bones to overlap in the birth canal to ease the birth process.

After a baby is born, a soft spot on the top of the baby’s head can be gently felt, known as the anterior fontanelle. This is the gap between the bones of the baby’s skull where they are yet to fuse together. This gap will slowly close as the infant ages, and can be felt for up to 12-18 months of age.

Until the bones of the skull are fused, they are susceptible pressure which can cause them to shift when sustained pressure on one part of the skull occurs. This is seen as a flattening or loss of roundness in this part of the baby’s skull.

What Causes This?

There are several factors that can lead to the flattening of the skull:

  • Prolonged time spent on their back: Infants who spend the majority of their time awake on their back, such as in cots or car seats, without altering their position are at an increased risk of plagiocephaly.
  • Head preference: When babies demonstrate a side preference, this can cause them to spend the majority of their time with pressure on the same part of their head.
  • Muscular Torticollis: This is a condition that is caused by a shortening or tightening of the neck muscles on one side. This can be seen with a head tilt and a side preference causing a baby to spend their time with pressure on one side of the skull.
  • In utero: Less commonly, babies can be born with flattening of their skull due to restricted movements within the womb due to a restricted uterine environment. This can occur in multiple births, breech position or even a small maternal pelvis.

Will It Change?

Plagiocephaly can be successfully managed conservatively using some clever strategies to change a babies environment and equalise the pressures on the skull.

If you are noticing any flattening of your baby’s head, remember that until their skull fuses together their head shape can continue to change.  With the right strategies this should slowly return to normal.  In this case, physiotherapy can help!

Strategies To Help:

It is important to remember that babies need to change the position that their head is in throughout the day.

  1. Back To Sleep
    From birth a baby should always be placed on their back to sleep to reduce the risk of sudden infant death syndrome (SIDs), with no pillows inside the cot. When the baby has fallen asleep, gently turn their head to the other side so that they are lying on the unfavoured side of their head.
    You can also put the baby to sleep at the other end of the crib, so that they must face their unfavoured side to see their bedroom door, and mum and dad when they come into the room.
  2. Tummy To Play
    It is very important for your baby to spend as much time on their tummy as they do on their back when they are supervised. This enables strengthening that they will need for crawling, sitting and rolling.
    This can start in small amounts of tummy time from birth, such as at nappy change. This can be hard for them to begin with, and some bubs will not be too pleased to be on their tummy. They will become stronger with practise and it will become easier. Just like going to the gym!
  3. Time On Their Back
    When the baby is lying on their back to play, try placing their favourite toys on their other side so they must turn their head to look at them. You can also use the bright lights and sounds of the television to get their attention and to look to their unfavoured side, and of course your voice as you play with them!
  4. Carrying Positions
    Try to change up the carrying and holding positions that you use. This is a clever way to get your baby looking to the other side throughout the day, and can even be used for gentle pressure on the other side of their head.
    For example, hold them upright for cuddles with their unfavoured side against your chest, or carry them on their side over your arm to encourage them to look the other way.

In summary, it is important that your new baby spends equal time on their tummy and their back throughout the day, ensuring equal time spent looking to each side to prevent constant pressure on one part of their skull. This can be achieved through play and cuddles throughout the day as you ensure everything interesting and fun is on their unfavoured side.
If you have any concerns that your baby is developing flattening on one side of their head, developing a side preference, or you simply have some questions regarding your new baby, pop in to play with one of our physiotherapists for a chat and an assessment to help alleviate your concerns.

Taylor is a Physio member of our team.  She works from our Penrith practice.