Positional Plagiocephaly and Infant Plastic Surgery

In a child's early months, the skull is soft and changes shape easily. Often a baby will get comfortable sleeping in a certain position every night, resulting in the flattening of a portion of his head. This was made more prevalent by the "back to sleep" campaign, which recommends that a newborn be laid on its back when it sleeps. This has resulted in fewer babies dying from SIDS, but it has also resulted in more cases of babies with positional plagiocephaly.

Most diagnoses of plagiocephaly however, are not permanent because the infant's head is elastic until about 18 months, and usually rounds out when encouraged to sleep in different positions. Unfortunately though, some infants don't cooperate and still sleep on the flattened side and do develop a more severe flattened skull which results in the head shifting forward and occurs in about 1 in 300 babies. Though positional plagiocephaly does not usually hinder the development of the brain, it is important to recognize the problem early to avoid plastic surgery. Usually just repositioning the head when the baby is sleeping works to solve the problem.

A more severe type of positional plagiocephaly is called craniosynostosis. This is where the skull has fused together earlier than it should. A pediatric neurologist can determine if this is the case by either feeling the head or performing a CT scan. If it is determined that the sutures have closed, plastic surgery will be needed to re-shape the head.

To prevent or correct positional plagiocephaly, you need to try to keep the baby from sleeping on the flat part of the head. This is not easy as sometimes the automatically goes back onto that side. Some things you can do to help the baby keep his head turned away from the flat area is to hang a mobile for the baby to look at in the direction that you want him to look. It is also recommended that you give the baby more of what is called "tummy time" to start sleeping on his tummy when he begins to roll over. You can also limit the amount of time the baby spends in a car seat, swing, or bounce seat, or use a specially made car seat so the child's head does not lay flat.

In some cases, the pediatric neurologist may recommend that the child wears a helmet for a few months so that the pressure can be kept off the head and the baby can sleep in whatever position he wants. This treatment usually starts before the baby is 8 months old and is used to treat more severe cases of plagiocephaly. This helmet will be made to fit your child and can be adjusted according to your child's growth.

If your child's head appears to be flat on one side, schedule an appointment with a pediatric neurologist who will determine what your next step should be.