Flattening of the head may be due to positional causes or craniosynostosis, an abnormal fusing of the sutures in the skull. Positional plagiocephaly is flattening of the head due to persistent head positioning and does not require surgical intervention. Craniosynostosis is premature fusion of the cranial sutures and may require surgical correction. Cranioynostosis in the back of the head or fusion of the lambdoid suture is extremely rare. The difference between positional flattening and craniosynostosis can usually be made on clinical grounds by your child’s pediatrician or a specialist despite the fact that they both result in flattening of the back of the head in both cases.
There has been an increase in referrals for plagiocephaly to neurosurgical centers and the incidence has increased six fold from 1992-1994. This is felt to be due in part, to the recommendation in 1992 from the American Academy of Pediatrics to avoid sleeping children on their stomachs as a measure to help prevent sudden infant death syndrome (SIDS).
Treatment for positional plagiocephaly may include such things as tummy time when the child is awake and may be supervised as well as making sure the child spends time upright in an exer-saucer or other such device, keeping them off the affected side. Other options include, putting the toys in the crib on the opposite side or feeding the child on the opposite side. Physical therapy may also be needed if the child has shortening of some of the neck muscles, a condition found in about 2-4 percent of newborns known as torticollis.
Watchful waiting and merely observing the child’s head shape over time may be an option depending on the severity of the deformity. In more severe cases, helmet therapy or a molding band may be used. This requires a visit to a person who specializes in making this equipment and is best started around 4-5 months of age. Typically, insurance companies do not cover this and they are quite expensive.
Therefore if parents are concerned about head shape they should bring it to the attention of their pediatrician during the monthly newborn checkups. The pediatrician may give them treatment advice or make the referral to a specialist if they feel it’s appropriate
Dr Gary Tye,Neurosurgeon