Sunday, March 13, 2011


Mom may be the first to notice it. As she is holding her tiny 3-month-old baby in her lap admiring perfect
fingers and toes, she looks down and sees a flat spot on the little head.

Plagiocephaly is the medical term for an abnormally shaped head caused by external forces. While still
inside mom, the head may be compressed due to cramped space as in the case of multiples, breech positioning, or lengthy time in the birth canal. Once the baby is delivered, the head will often correct on its own in the first six weeks of life.

But sometimes things don't get better with time. Sometimes, other factors exist that make things more difficult. These factors can vary from simple routines where the baby's head rests on a hard surface (car seat, stroller, swing, etc) for extended periods to more complicated issues like muscle imbalances of the neck and trunk. Then when a baby sleeps on the back, as recommended by the American Academy of Pediatrics to reduce risk of sudden infant death syndrome, the flat spot never has a chance to correct.

Often dismissed as a purely cosmetic issue, there can be growth and developmental implications to the diagnosis of plagiocephaly. Fortunately, with early recognition, intervention and proper treatment, many head shapes can be corrected to normal.

Conservative treatment is watchful waiting to see if the head will correct on its own. Pressure is greatly reduced once a baby has enough strength to hold up his head and to roll over. Mom and dad can help by giving their baby lots of tummy time. If muscle imbalances seem to be the culprit, a physician will refer the infant to be evaluated and treated by a therapist to help stretch and strengthen muscles.

In the case of moderate to severe deformity, a cranial remolding helmet is required and a physician will refer the baby to an orthotist for evaluation and treatment. An impression of the infant's head is taken and a helmet will be made to help correct the shape as the child grows. The helmet provides gentle pressure to hold sections of the head, which have appropriate shape and voided areas to allow the head to round out where needed.

Helmet treatment is generally started between 6 and 12 months. Generally, the sooner a child gets a helmet, the faster the head corrects since the growth rate of the head is fastest in the first 12 months of life. Treatment is possible until around 18 months of age , at which time the bones in the head will fuse together in a permanent shape. Early identification is the key to successful treatment.

Tips to improve head shape at home
-when your baby is awake provide supervised tummy time as much as possible
-do not spend prolonged periods of time in a car seat
-alternate crib sleeping position as a baby will tend to look toward the door or light source
-after your infant has fallen asleep, rotate the head off of the flattened area
-alternate your arm carrying position so that both sides of the body develop strength symmetrically
-let your baby lay on his/her tummy on your chest
-alternate diapering and bathing position as a baby will tend to look at you during these activities

Mary Fischer is a Certified Prosthetist Orthotist at ADAPT Prosthetics & Orthotics.

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