This is a disorder that affects the skull making the back or sides of the baby’s head appear flattened or deformed.

The skull is made up of five bones with gaps between the bones, called sutures. The gaps allow the bones to move during the birth to facilitate the baby's passage through the birth canal. They also allow for the rapid increase in the skull and brain, reflecting the general growth of the nervous system during infancy. Fusions of the sutures occur gradually and are usually fully fused by the time the baby is around 19 months old. During this time outside pressure on any part of the skull before, during and after birth can result in positional plagiocephaly.

Positional plagiocephaly is not life threatening, it does not cause pressure on the baby's brain or cause brain abnormalities, development is not affected and improvement without treatment is common. However it has become more prevalent since parents were advised to put their babies down to sleep on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS). It is important to remember that this advice has been beneficial and that it is still recommended to place babies on their backs to sleep.

Causes

• Babies are spending more sleep time lying on their backs on firmer mattresses or sitting in car seats resulting in pressure on the skull and moulding it into a flat or distorted shape.
• Some babies may have a tendency to turn their heads to one side or the other and the skull then becomes deformed on the preferred side.
• Neck muscles can be tight or go into spasm (torticollis) preventing the baby easily turning the head resulting in a positional plagiocephaly.
• Premature babies, twins and multiple births are more at risk of plagiocephaly.
• It can also be caused by early joining of the gaps between the skull bones (craniosynostosis) and this type requires surgical treatment.

Diagnosis

Prevention
Positional plagiocephaly can be prevented by changing the resting position of the head frequently.

• Position young babies (from birth - four months) on their backs for sleep and turn the infants head to the right for two nights and to the left for two nights and two nights on the centre. This can be done by placing a rolled up towel underneath the mattress so that the head flops to the side. Alternating the pressure points in the head will reduce the risk of positional plagiocephaly
• During the day while babies are awake they should be allowed to experienced different positions under supervision. Alternating between a sling, a buggy, pram and bouncy chair will prevent pressure on any one area of the skull.

Treatment
The head shape can be naturally improved in several ways by

• Early recognition - the younger the child the better the chances of early correction
• Tummy time - Babies must be put down to sleep on their backs but spending playtime on their tummies will allow natural correction to begin. It will also improve their head control and allow them to learn to lift their heads and have a look around.
  
• For babies who have a tendency to turn the head to a particular side altering the position of the cot, toys or mobiles will encourage the baby to turn in the direction that is most interesting and exciting.
• A rolled up towel under the mattress on the flattened side will encourage the baby to rest on the most prominent side and over time the head will correct naturally.
• Physiotherapy can be very helpful for babies who find it difficult to turn their heads in one direction and where there is torticollis.
• Treatment with the use of helmets and bands is available. The helmets are moulded to the exact shape of the head and restrict growth in the part that bulges encouraging and channeling the growth into the misshapen area. The helmet is worn by the baby for 23 hours a day for four to six months or longer.
• Treatment with helmets is available in some areas on the NHS and may be available in other areas in the future once the research into their use has been completed. To find out about availability it is best to contact NHS Trusts. It is also available privately.

Frances Byatt-Smith RN RHV BA Psychology

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