Petra Spiess
The "Back to Sleep" campaign encourages parents to put their infants to sleep on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS). Although SIDS deaths have declined almost 50% since the 1992 implementation of this campaign, it has led to an epidemic increase in another problem, positional plagiocephaly.
Since many parents follow the "back to sleep" advice, their babies are placed on their backs to sleep every night, and spend a lot of time in baby carriers or carseats, which put pressure on the back of the skull that can cause it to flatten. Infant skulls are composed of several different plates, which don't fuse together until they are older, so their skulls are malleable. When placed under constant pressure from being slept on, or always laying in one position, the favored side of the head can become flat or misshapen, which is called positional or deformational plagiocephaly. Plagiocephaly can cause noted facial asymmetry, which understandably, is very upsetting to parents. Additionally, some studies have shown a link between plagiocephaly and developmental delays or difficulties.
Plagiocephaly is not only caused by back (or any one consistent side) sleeping, but also can occur in the womb if the baby does not have enough room to move around, or gets jammed in a particular position, and is especially common with multiple pregnancies. A condition called torticollis can also lead to plagiocephaly. Torticollis is a condition where the muscle on one side of the neck is short or tight, which causes the head to tilt in a particular direction. As a consequence, affected babies will always rest with the same side of their head down.
The first person to notice symptoms of plagiocephaly is usually a parent or pediatrician. It's important to diagnose plagiocephaly as soon as possible; treatment methods are most effective when used before 12 months of age. Treatment after this time has found to be of little benefit.
Karen Auge, a parent from Lansing, Michigan whose daughter was born with plagiocephaly comments, "My big regret is that my pediatrician didn't diagnose my daughter and it took me too long to get to a specialist. I am not sure my pediatrician had ever seen this condition and plagiocephaly was never mentioned. Additionally, my daughter was a stomach sleeper and all info I had heard only discussed 'flat heads' from back sleeping. We got correction but not 100% due to her late start [of treatment]."
The two main treatments for plagiocephaly are repositioning and a custom-designed helmet that molds the child's head back into a normal shape; very rarely, surgery may be needed if other methods fail to show improvement. Repositioning involves alternating which side of the head the baby rests on (while still putting the baby to sleep on his/her back), and providing "tummy time" when the baby is being watched and is awake.
"It is important for parents to know that plagiocephaly can often be prevented and/or corrected by repositioning," advises Dr. Kevin Kelly, a research scientist in the Occupational and Environmental Health Department at the University of Iowa, and administrator of the www.plagiocephaly.org website. If repositioning is not effective after two to thress months, parents will need to have their child reevaluated by specialists who may recommend a corrective helmet.
"[My son's] head was lopsided if you looked at it from the top down and from behind. [The nurse at my son's doctor's office] told us we should try repositioning him and she would look at it again at his 4-month appointment. At the 4-month appointment, it had not changed, so the doctor referred us to a craniologist," relates Holly Cornish from Los Angeles, California, whose son was diagnosed with congenital muscular torticollis and deformational plagiocephaly at five months.
Corrective helmets for plagiocephaly are composed of an inner foam liner and a plastic outer shell. They are custom designed and fitted, and must be adjusted on a weekly or bi-weekly basis. The helmet should be worn 23 hours a day, with one hour off for bathing. The length of treatment varies with the severity of the problem but averages two to six months.
"The helmet looks worse and feels worse for parents than the kids," says Karen Auge. Many studies have shown these treatment helmets are very effective (when used within the right time frame) for treating plagiocephaly, but some insurance companies will not cover their cost, arguing the treatment is cosmetic only.
"Left untreated, children may experience other medical issues later in life. In addition, one should not (cannot) understate the importance of simply 'looking normal' to a child's emotional and social development, particularly as children grow into their teens," says Dr. Kelly.
Plagiocephaly is not the only cause of abnormal head shapes in infants, but is the most common. Although very concerning to parents, plagiocephaly can be very successfully treated when diagnosed early.
Petra Spiess is a freelance writer in Westminster, Colorado.
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