Description, Causes and Risk Factors:
Congenital malformation of the skull in which the main axis of the skull is oblique (slanting or inclined in direction or course or position--neither parallel nor perpendicular nor right-angled).
The skull is made up of several `plates' of bone which, when we are born, are not tightly joined together. As we grow older, they gradually fuse - or stick - together. When we are young, they are soft enough to be moulded, and this means their shape can be altered by pressure on it to give part - usually the back - of a baby's head a flattened look.
Plagiocephaly is a disorder that affects the skull, making the back or side of a baby's head appear flattened. It is sometimes called deformational plagiocephaly. Positional plagiocephaly is much more common now. Some reports estimate that positional plagiocephaly affects around half of all babies under a year old but to varying degrees. As improvement, even without treatment, is common, it is difficult to get a true estimate.
Causes: At birth, an infant's skull is made up of several bones connected by sutures (joints). The sutures help the head pass through the birth canal, and also allow room for the brain to grow. After birth, the quickly growing brain continues to shape the bones of the skull.
Pressures from the outside can also shape the skull. Plagiocephaly is usually positional. It develops when an infant sleeps or rests on one part of the head most of the time. It has become more common because parents are now advised to place infants on their backs for sleep to help prevent sudden infant death syndrome (SIDS). Extended use of car seat carriers, swings, and bouncers also place infants on their backs for long periods of time and may change head shape.
Sometimes plagiocephaly results from torticollis, a condition that shortens or tightens the neck muscles, making headturning difficult. All babies with plagiocephaly should be checked for torticollis. It is very important to treat torticollis with physical therapy, as it can cause long-term problems. Rarely, plagiocephaly occurs when one or more of the sutures closes too early. This is usually treated with surgery.
Rarely, plagiocephaly occurs when one or more of the sutures closes too early. This is usually treated with surgery.
It does not seem more common in one race than another and affects males and females equally. It seems to affect premature babies more often than those born at term. This is probably because the skull plates become stronger in the last few weeks of pregnancy.
Positional plagiocephaly is usually easy for parents to notice. Typically, the back of the child's head (called the occiput) is flattened on one side, and the ear on the flattened side may be pushed forward as viewed from above.
In severe cases, there may be bulging on the side opposite from the flattening and the forehead may be asymmetrical (or uneven). If torticollis is the cause, the neck, jaw, and face may be asymmetrical. But although other aspects of the head and face may be affected, in positional plagiocephaly the back of the head is always most involved.
If a baby is not showing any other symptoms, the doctor will probably make the diagnosis by physical examination. The story is often characteristic too - the head shape was normal at birth and the flattening was first noticed at the age of two or three months. If your doctor has any doubts about the diagnosis, the baby may need some other tests, x-rays or CT scans to rule out other problems.
In mild cases, babies will not need any active treatment. There are several ways of encouraging natural improvement in the shape of the head:
`Tummy time': we are not suggesting that a baby should sleep on their tummy while still young, but the more time babies spend on their tummies, the better the chance of stopping the plagiocephaly getting worse - and allowing natural correction to begin. So play with them on their tummy. Babies like to learn to lift their heads and look around them.
Sleeping pattern: adjust a baby's sleeping pattern so that everything exciting is in the direction that encourages them to turn their head the wrong way - for example, alter the position of any toys or mobiles. A rolled up towel under the mattress can help the child sleep with less pressure on the flattest part of the head. Check how they are lying in the car seat or buggy too.
Physiotherapy: for those children with difficulty turning the head in one direction, physiotherapy can be very helpful. The sooner the head turns as easily one way as the other, the sooner natural correction of head shape can begin.
Helmets and bands: the use of these remains controversial. If all the actions listed above are taken, does a helmet add anything? The answer is that we do not know for sure. They often have to be worn for several months and for 23 hours out of 24. If they are to be effective, it would seem sensible to start using them when the head is still `plastic' enough to have the natural correction process encouraged by restricting growth in the `bulgy' parts of the head while encouraging growth in the flatter areas by leaving them free - preferably before six months.
Early recognition of the plagiocephaly: the younger the child is when it is recognized, the better the chances of improving it.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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