Deformational plagiocephaly

Deformational (or positional) plagiocephaly refers to a misshapen (asymmetrical) shape of the head (cranium) from repeated pressure to the same area of the head. Plagiocephaly literally means "oblique head" (from the Greek words "plagio" for oblique and "cephale" for head).

How is deformational plagiocephaly different from craniosynostosis?

Craniosynostosis is premature fusion of one or more of the sutures in the skull. True synostosis may limit the size of the cranial vault (skull) and therefore impair brain growth. The diagnosis is made after a clinical evaluation by a craniofacial surgeon and/or a neurosurgeon. X-rays and CT scans of the head may be performed to confirm the diagnosis of craniosynostosis. Surgery is usually the recommended treatment.

In deformational plagiocephaly, there is no fusion of the skull sutures. It is a clinical diagnosis made after a thorough medical history and physical examination by a craniofacial surgeon or neurosurgeon. X-rays and/or CT scans are usually not necessary. Treatment of deformational plagiocephaly generally includes positioning and/or helmeting.

The major differences between craniosynostosis and deformational plagiocephaly are summarized in the chart below:

What causes deformational plagiocephaly?

By keeping an infant's head in one position for long periods of time, the skull flattens (external pressure). Occasionally, a baby is born with this flattening because of a tight intrauterine environment (i.e., in multiple births, small maternal pelvis, or with a breech position). Other factors which may increase the risk of deformational plagiocephaly include the following:

• muscular torticollis - One cause of deformational plagiocephaly may be muscular torticollis. Muscular torticollis is a congenital (present at birth) finding in which one or more of the neck muscles is extremely tight, causing the head to tilt and/or turn in the same direction. Torticollis is often associated with the development of plagiocephaly since the infant holds his/her head against the mattress in the same position repeatedly.
• prematurity - Premature infants are at a higher risk for plagiocephaly since the cranial bones become stronger and harder in the last 10 weeks of pregnancy. Also, since many premature infants spend extended periods of time in the neonatal intensive care unit (NICU) on a respirator, their heads are maintained in a fixed position, increasing the risk for this condition.
• back sleeping - Infants who sleep on their backs or in car seats without alternating positions for extended periods of time are also at a higher risk for deformational plagiocephaly.

Is deformational plagiocephaly becoming more common?

In 1992, the American Academy of Pediatrics (AAP) recommended infants sleep either on their backs or sides to reduce the risk of sudden infant death syndrome (SIDS). Since then, medical providers have noted a significant increase in the number of infants presenting with deformational or positional plagiocephaly. These deformations are positional in nature, because of the extended time an infant spends lying supine (on his/her back) in a crib, car seat, or infant swing.

Treatment for deformational plagiocephaly:

Specific treatment will be determined by your child's physician based on the severity of the deformational plagiocephaly. Frequent rotation of your child's head would be the first recommendation once your infant has been diagnosed with plagiocephaly. Alternating your infant's sleep position from the back to the sides, and not putting infants on their backs when they are awake may also help prevent and treat positional plagiocephaly. Some cases do not require any treatment and the condition may resolve spontaneously when the infant begins to sit.

If the deformity is moderate to severe and a trial of re-positioning has failed, your child's physician may recommend a cranial remodeling band or helmet.

How does helmeting correct deformational plagiocephaly?

Helmets are usually made of an outer hard shell with a foam lining. Gentle, persistent pressures are applied to capture the natural growth of an infant's head, while inhibiting growth in the prominent areas and allowing for growth in the flat regions. As the head grows, adjustments are made frequently. The helmet essentially provides a tight, round space for the head to grow into.

How long will my child wear a helmet?

The average treatment with a helmet is usually three to six months, depending on the age of the infant and the severity of the condition. Careful and frequent monitoring is required. Helmets must be prescribed by a licensed physician with craniofacial experience.