What are Plagiocephaly and Brachycephaly?

Plagiocephaly and Brachycephaly are terms that refer to flatness in the shape of the head. Plagiocephaly refers to flattening of the head in any of the four quadrants of the cranium (back, front, left, right). It is this condition that often results in the asymmetry of the head and face. The ear, forehead and cheek bone on the flattened side of the head will protrude forward. Brachycephaly means that either the front or the back of the head lack projection. This condition is not usually characterized by asymmetry of the ears and facial bones.

What causes a misshapen head?
The following may be causes of an improper development of the head shape among infants:
- Prolonged lying on the back;
- Torticollis;
- Misalignment of the body;
- Delivery at birth;

Misshapen heads have become markedly more common, following the Back To Sleep Program designed to prevent Sudden Infant Death Syndrome (SIDS). There has been a 40% decrease in SIDS since infants have been put to sleep on their back rather than their stomachs. However, prolonged lying on the back is one of the causes of children developing a misshapen head.

Torticollis is a condition consisting of a spasm in the neck which prevents turning the head equally in both directions, which may cause a child to favor looking either in the left or right direction. Torticollis should be corrected as soon as possible or the face and head of a child may not develop symmetrically. It is advisable to seek the assistance of a trained practitioner early in the onset of the condition for an assessment and treatment.

Various reasons may lead to a misalignment of the body among infants. Common causes are relatively large babies born from a small maternal pelvis, or multiple infants (twins) leading to crowding in the womb. In the case of twins, occasionally, one twin is more compressed than the other in the womb. Sometimes a baby’s head may become stuck in its mother’s pelvis or under her ribs, restricting the infant’s movement. In one case I assessed it was possible to see where the maternal ribs had pressed into the top of the baby’s head. When a baby’s pelvis is misaligned, the position of the head and neck will also be affected.

Given the softness of an infants bones, difficult or assisted deliveries, particularly when instruments such as ventouse or forceps are utilized, may alter the alignment of the head and facial bones. Forceps can leave an impression on the bones of the head, and ventouse can cause elongation of the head. Sometimes it will correct itself, depending on the amount of force used in delivering the baby safely.

Mothers often assume that baby’s condition is somehow their fault, wrongly believing the way they hold their baby or wash his hair is responsible. This is certainly not the case.

Some believe the condition is hereditary, when it can actually result from a normal delivery. For example, one eye can be smaller and higher on the face; this is actually a facial slant. The facial bones drag along the mother’s tail bone and depending on the size of the head, the size of the pelvis and the position of the tailbone, there will be a more prominent facial slant. Around 70% of facial slants occur on the left side, as most natural deliveries lead with this side. Often the bone on the back of head will also rotate, causing a less rounded skull.

Prevention

Crying & Sucking
Crying and sucking both help to shape a baby’s head. If using a bottle
to feed baby, make him work harder by using a slow flow teat. This will contract the connective tissue, helping to shape the head.

Check Your Baby’s Alignment
Get a professional to check out your baby’s alignment after a few weeks of age. This gives the body and head a chance to stretch out and reshape. If this does not happen,
have someone trained in working with infants check and treat any misalignment of
the pelvis, spine or head. If you had a c-section with no complications and the head shape is perfect, arrange to see a therapist trained in head shaping if it suddenly starts to become flat.

Tummy Time
Make sure baby has tummy time six times per day. You should do this for as long as he can tolerate it, even if it is only for 30 seconds. This not only takes pressure off the back of the head, but also strengthens the neck muscles to help with reshaping the head. Many of the neck muscles are attached to the sides of the face and skull.

Head Brace/Helmet
Head braces or helmets may be considered for children who have not had the misshapen head condition corrected during early infancy, when the condition is more easily and more effectively corrected. Head braces or helmets are not fitted on children less than eight months of age. The helmet is worn for about 9-12 months, 23 hours a day, and requires adjustments every six weeks or so.

Other Tips
- Alternate sleeping positions from back to side, to the other side.
- Do not let your baby stay in a car seat or stroller for long periods of time.
- If you bottle feed, alternate the sides on which you hold your baby.

When should I seek help?
If you are concerned about your child, be proactive and seek help. A child does not outgrow this condition, although it may improve slightly with time. When a child grows hair it is less noticeable, but the problem is still there, so the sooner you seek treatment, the better.

An infant has seven soft spots in his head, and there is a lot of movement between the skull bones. The first one starts to fuse after two months; this is the forehead, which is in two pieces in a child. I have seen MANY children come in for head shaping between the ages of nine months and 30 months; it is too late to achieve significant change, but some valid work can still be done. It can also be time consuming with a toddler who cannot lie still, so the treatment takes longer. The earlier you seek treatment, the more effective it will be.

by Caroline Rhodes from The Body Group