There are two primary head shape concerns that we see in our practice – positional plagiocephaly and craniosynostosis.
Positional plagiocephaly
Positional plagiocephaly, also known as flat head syndrome, is a common condition that affects infants and young children. The term “plagiocephaly” is derived from two Greek words: “plagio” (meaning oblique or slanting) and “cephaly” (meaning head). This condition occurs when a baby’s head develops a flat spot due to prolonged pressure on one area. While positional plagiocephaly is generally considered a cosmetic issue, it can lead to potential developmental problems if left untreated.
The prevalence of positional plagiocephaly has increased in recent years, coinciding with the American Academy of Pediatrics’ recommendation in 1992 to place infants on their backs to sleep to reduce the risk of sudden infant death syndrome (SIDS). This “Back to Sleep” campaign has been highly effective in reducing SIDS cases but has also contributed to a rise in the occurrence of flat head syndrome.
The primary cause of positional plagiocephaly is the consistent pressure exerted on the infant’s soft and malleable skull bones. Infants’ skulls are not fully fused, and they have several soft spots called fontanelles, which allow for brain growth and accommodate the baby’s head during delivery. However, this also makes their heads vulnerable to deformation if subjected to constant pressure in a particular spot.
Several factors can contribute to the development of positional plagiocephaly, including spending prolonged periods lying in the same position, limited neck mobility, muscle imbalances in the neck, premature birth, multiple births (e.g., twins or triplets), and medical conditions that restrict movement. Additionally, the increasing use of baby gear, such as car seats, bouncers, and swings, may also contribute to the condition, as these devices can put additional pressure on the baby’s head.
While positional plagiocephaly does not pose immediate health risks, it is essential to monitor its progression and take preventive measures to avoid potential complications. Parents can adopt several strategies to reduce the risk of positional plagiocephaly and promote healthy head development in their infants:
- Tummy Time: Providing supervised tummy time when the baby is awake and alert helps develop neck and upper body strength, reducing the likelihood of developing a flat head.
- Frequent Repositioning: Regularly changing the baby’s head position during sleep and playtime prevents prolonged pressure on one area of the skull.
- Babywearing: Using baby carriers instead of leaving the baby in a car seat or other restrictive devices allows for more natural head movement and prevents prolonged pressure on the head.
- Alternate Sleeping Positions: Alternate the baby’s head position between the left and right sides when placing them in the crib to avoid consistent pressure on one side.
- Adjust the Baby’s Environment: Placing interesting toys or objects on one side can encourage the baby to turn their head and prevent favoring one direction.
- Consult a Pediatrician: If parents notice any flattening or asymmetry in their baby’s head shape, they should consult a pediatrician or healthcare provider for proper evaluation and guidance.
In mild cases, repositioning techniques and implementing preventive measures can help resolve positional plagiocephaly. However, severe or persistent cases may require additional interventions, such as physical therapy or cranial remolding helmets. These helmets are custom-made to apply gentle pressure on the baby’s skull, guiding its growth and promoting a more symmetrical head shape.
In summary, positional plagiocephaly is a prevalent condition that affects many infants due to increased awareness of safe sleep practices. While it is usually a cosmetic concern, parents and caregivers should take proactive steps to prevent its development and seek professional advice if they notice any abnormal head shape. With early intervention and the implementation of preventive measures, positional plagiocephaly can be effectively managed, allowing infants to grow and develop healthily.
Craniosynostosis
Craniosynostosis is a congenital condition characterized by the premature fusion of one or more sutures in an infant’s skull. The term “craniosynostosis” is derived from two Greek words: “cranio” (meaning skull) and “synostosis” (meaning bone fusion). Normally, an infant’s skull is made up of several bone plates separated by sutures, flexible joints that allow the skull to expand and accommodate the growing brain. However, in craniosynostosis, one or more of these sutures close too early, resulting in an abnormal head shape and potential complications.
The exact cause of craniosynostosis is not always known, but it is believed to be influenced by a combination of genetic and environmental factors. In some cases, it may be associated with genetic syndromes or mutations. Additionally, certain risk factors, such as maternal smoking during pregnancy or certain medications, may increase the likelihood of craniosynostosis.
The premature fusion of sutures leads to restricted skull growth in the affected area, resulting in an abnormal head shape. The severity and location of the cranial fusion determine the specific type of craniosynostosis. Some common types include:
Sagittal Craniosynostosis: This is the most frequent type, where the sagittal suture, running along the top of the head from front to back, fuses prematurely. It causes the head to become long and narrow, a condition known as scaphocephaly.
Coronal Craniosynostosis: In this type, one or both of the coronal sutures, which run from each ear to the top of the head, close early. It leads to a flat forehead and an elevated, tall skull on the affected side.
Metopic Craniosynostosis: The metopic suture, which runs down the middle of the forehead from the top to the nasal bridge, fuses prematurely in this type. This results in a ridge-like prominence on the forehead and a triangular forehead and, known as trigonocephaly.
Lambdoid Craniosynostosis: The lambdoid suture, located at the back of the head, fuses prematurely in this type. It causes the back of the head to appear flattened and asymmetrical on the affected side.
Diagnosis of craniosynostosis is typically made through a physical examination by a pediatrician or a pediatric craniofacial specialist. In some cases, imaging studies like X-rays, CT scans, or 3D imaging may be used to confirm the diagnosis and assess the severity of the condition.
The main concerns with craniosynostosis are the potential impact on brain growth and development and the psychosocial impact of atypical head shape if the condition is not addressed. If untreated, the abnormal head shape can lead to increased intracranial pressure (ICP) due to limited space for the growing brain. Elevated ICP can result in developmental delays, vision problems, and neurological issues.
Early diagnosis and intervention are crucial for managing craniosynostosis effectively. Treatment typically involves surgical intervention to release the fused sutures and allow for proper skull growth. The surgical procedure is known as cranial vault reconstruction or cranial remodeling. Depending on the type and severity of craniosynostosis, different surgical techniques may be employed.
Surgery for craniosynostosis is generally safe, and most infants recover well with the appropriate post-operative care. After surgery, the child may need to wear a molding helmet to help shape the skull as it continues to grow and heal.
Long-term outcomes for infants with craniosynostosis can vary, depending on the type of craniosynostosis, the timing of intervention, and the presence of any associated conditions. Early diagnosis and treatment significantly improve the prognosis, allowing affected children to lead healthy and fulfilling lives.
In summary, craniosynostosis is a congenital condition characterized by the premature fusion of one or more sutures in an infant’s skull. Early diagnosis and appropriate surgical intervention are essential for managing the condition and preventing potential complications. With the right medical care, children with craniosynostosis can thrive and reach their developmental milestones, paving the way for a bright future.