Understanding Plagiocephaly (Flat Head Syndrome)

What is plagiocephaly?

Plagiocephaly… sounds like a pretty scary word, but honestly, it is just the medical term for an asymmetrical head shape.  The roots “plagio” and “cephal” mean “oblique, slanted” and “relating to the head” respectively.

Asymmetrical head shapes are fairly common these days with some reports that 45% of infants have plagiocephaly in some form. Incidences of plagiocephaly have significantly increased since the “Back to Sleep” campaign of the 80’s where parents were encouraged to keep their babies off of their bellies during sleep. The reasoning behind this is the strong link between SIDS (sudden infant death syndrome) and being positioned belly-down for sleep prior to 6 months of age. This, of course, means that babies started spending a lot more time on their backs. It also means that a lot of parents have more anxiety about positioning their babies on their bellies. But that’s another topic. 

What are the three types of plagiocephaly?

Plagiocephaly, Scaphocephaly, and Brachycephaly. 

Plagiocephaly is the most common type of atypical head shape. The head takes on a “parallelogram-like” shape due to lying down with pressure more on one side of the head  than the other. Babies with general plagiocephaly usually have flattening of the rear of their skulls on one side, not centered. More involved plagiocephaly can include flattening and asymmetry of the baby’s face as well.

Brachycephaly describes a head shape that is wide and flat at the rear. This head shape is common for babies who have had medical issues that have required them to lie flat for extended periods of time, or babies that spend a good amount of their day in car seats, bouncers, and swings.

Lastly, Scaphocephaly describes a narrow, elongated head shape. This shape is more common in babies born prematurely.  This shape poses a unique challenge because babies with scaphocephaly have difficulty keeping their head centered, usually keeping their head turned to either side.

Why does my child have plagiocephaly? 

There are many reasons for why your child may have developed plagiocephaly: 

• In-utero positioning

• postural preferences (possibly caused by torticollis) 

• first born babies due to less uterine capacity

• increased time lying on their backs with head against firm surface in car seats, bouncers, swings

The sutures of infants’ skulls are soft and malleable. This is particularly important when exiting the birth canal. In fact, infants’ skulls collapse slightly when they enter the world through their mother’s vaginal canal. This helpful malleability also means that head shape can change significantly based on the forces that are applied to it. 

If your child is in the same position in-utero for many months, then you can see how a soft malleable skull would come out in an asymmetrical shape. Often times babies enter the world with round heads, but quickly develop plagiocephaly due to postural preferences, such as always keeping their head turned to one side. If your baby prefers to look to the right, and spends a lot of time on their back (as most newborns do), gravity will begin to shape their soft head into more of a parallelogram shape than a circle. The good news is we can use this same malleability to correct their head shape with strategic positioning exercises.

What should I do if my baby has a flat spot?

Infant physical therapists are uniquely qualified to treat plagiocephaly. If your child is seen before 4 months of age, there is an extremely good prognosis. Significant change in head shape can happen with a commitment to repositioning at this young age. Often, a helmet can be completely avoided. If you wait until after 6 months, prognosis goes down significantly. When it comes to plagiocephaly. Early action is more important than ever. As your baby ages, the malleability of their skull  decreases as sutures start to fuse together and form a more solid skull. In order to take advantage of the skull’s ability to reshape, it is important to start treatment prior to four months of age.

Making sure that your baby’s neck can move well in all directions is an important part of treating plagiocephaly.

Need help?

I started my career treating infants with torticollis and plagiocephaly, and have continued to do so throughout my 15+ years working in pediatrics! I have advanced training on how to treat plagiocephaly without a helmet, including strategic positioning and stretching techniques. Do you have a baby with a not-so-round head shape? Reach out today for an evaluation… Don’t wait! I offer free consultations where we can get all of your questions answered prior to beginning treatment. I look forward to hearing from you and answering any additional questions you might have.

Understanding Torticollis

Finding out that your baby has torticollis is scary. It doesn’t help that this diagnosis has such a scary name: torticollis. What is torticollis? How did my baby end up with it? What can I do about it? These are the questions I hope to answer for you today.

Torticollis is the tightening of the sternocleidomastoid muscle (SCM)  in your baby’s neck. This muscle is responsible for both rotating and side bending your baby’s head. When this muscle is tight, your baby most often has a preference to look in one direction and rests with their head tilted to the other side.

The Latin roots for the word “torticollis” mean twisted (“tort”) and neck (“collis”). Because the SCM attaches behind the ear at your baby’s mastoid process and at their sternum, when this muscle is tight, it pulls your baby’s head into a rotated and side bent position. Most parents notice that their child prefers to look only to one side, or they keep their head tipped to one side, or both.

Other signs/symptoms of torticollis may include:

• preference to move one arm more than the other

• leaning to one side when on belly or in sitting

• decreased tolerance to side lying position

• difficulty with tummy time

Almost always, your baby’s torticollis started from their position in the womb. Torticollis is more common in babies of larger size and of multiples where there was likely less space for your baby to stretch out. It is important to understand that your baby’s diagnosis is NOT your fault! Torticollis is very common, but not commonly discussed. You are not alone.

If you are reading this post about torticollis, you are already on your way to helping your child. Understanding the diagnosis of torticollis is one of the most important steps in treatment. When it comes to torticollis, the concept of early intervention, that is, “Earlier action leads to better and faster outcomes,” could not be more true. Studies have shown that starting physical therapy treatment for torticollis prior to 2 months old leads to almost 99% resolution in less than 2 months.

Physical therapy treatment of torticollis includes lots of education, strategic play positions to stretch and strengthen your baby’s muscles, and focus on symmetrical posture and movement. I have helped numerous babies work through their torticollis and successfully meet their milestones.

I would love to help your baby! I offer convenient in-home physical therapy. Reach out today for a free consultation or schedule an evaluation ASAP.

I look forward to meeting you and your sweet baby.

How to Make Tummy Time Easier

As a new parent, I’m sure you have heard about how important it is to do tummy time with your baby. But, has anyone explained WHY it is important?

If you are like me, you like to know the WHY behind things…let me help you with this!

As newcomers to our world, babies “workout” by moving their body against the force of gravity. Since new babies spend a lot of time on their back, this gives them plenty of opportunity to strengthen the muscles on the front of their bodies, mostly the muscles that perform flexion movements, very well.  

When we put our babies on their bellies, we are TOTALLY changing the game. Now your baby has to use the muscles opposite to those they are most used to using, the muscles that perform extension movements. This is HARD work!

Tummy time can be frustrating to babies and their parents because it is so challenging. Have no fear, I’m here to help! There are LOTS of ways to modify tummy time to make it easier for everyone.

Before providing some tips, I have to share my 3 rules of tummy time:

1. QUALITY of  tummy time is much more important than QUANTITY of tummy time

2. If your baby is upset in tummy time, it is time to take a break. Even better if you can read your baby’s cues and take a break BEFORE they are upset.

3. Help your baby feel the transitional movements in and out of tummy time.

Quality tummy time means that your baby is supported with their arms tucked under their shoulders. They are lifting their head and pushing through their arms. It is OK if you need to help them be successful with this…I will share tips for that in a bit. Quality tummy time can be 10-15 seconds at a time. You will quickly notice that your baby can tolerate more, but they need to start somewhere!

Making sure that your baby doesn’t associate being on their belly with being upset is important. Try doing tummy time in front of a mirror, so that you can monitor your baby’s facial expressions and “roll out” before they get upset.  Also listen to your baby. There is a big difference between “hard working” noises, and being upset.

Lastly, learn how to safely roll your baby onto their belly and off. It is important for your baby to begin to get comfortable with movement, especially because we will be expecting them to complete these movements without help in the near future.

Now that we have the RULES out of the way, let me share some tips with you. I suggest trying each of these alone, and pairing some together. It is totally OK to help your baby with their tummy time, especially at first. You will be amazed with how quickly you can peel back some of this help.

Inclines

Placing your baby on an inclined surface with their head/shoulders above their hips, reduces how hard they have to work against gravity (think: doing a plank on the floor is much harder than having your hands up on a bench). Your chest can be an inclined surface if you sit in a reclined position. You can also prop up one end of a couch cushion to make your own inclined surface.

Physical Support

Initially it is helpful to provide physical support at your baby’s shoulders, helping them to position their arms under their shoulders to create a solid base of support. As your baby gets stronger, you can move your hands down their body to support them at their trunk or pelvis. When you provide a point of stability for your baby, they are usually much more successful lifting their heads and pushing with their arms.

You can learn many more Tummy Time tricks and tips at one of my Tummy Time Workshops.. I would LOVE to have you there. You can explore available dates here: Workshop Scheduling