Plagiocephaly

Definition:
The skull isn’t perfectly smooth – it’s covered with lumps, dips and some flatter areas. But sometimes a large area of flattening distorts the skull, making it look parallelogram-shaped. This is known as plagiocephaly.

The most common form is positional plagiocephaly. It occurs when a baby’s head develops a flat spot due to pressure on that area. Babies are vulnerable because their skull is soft and pliable when they’re born.

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Positional plagiocephaly typically develops after birth when babies spend time in a position that puts pressure on one part of the skull. Because babies spend so much time lying on their back, for example, they may develop a flat spot where their head presses against the mattress.

Starting in the early 1990s, parents were told to put their babies to sleep on their back to reduce the risk of SIDS. While this advice has saved thousands of babies’ lives, experts have noticed a fivefold increase in misshapen heads since then.

More rarely, babies develop positional plagiocephaly when movement in the uterus is constricted for some reason – because their mother is carrying more than one baby, for example. It can also happen to breech babies who get wedged under their mother’s ribs.

Another type of plagiocephaly is craniosynostosis, a birth defect in which the joints between the bones of the skull close early. Babies born with craniosynostosis need surgery to allow their brain to grow properly.

Symptoms
Plagiocephaly may become apparent at different ages, depending on the cause. Some babies are born with a flat head (this may be a temporary deformity due to the baby’s passage down the birth canal), while others develop it later as the bones of the skull fuse. The abnormal shape can best be seen if you look down on the baby’s head from above.

Signs of plagiocephaly include:
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•Parallelogram-shaped skull when viewed from above
•Flattening on one side at the back of the head, with a compensatory protrusion or bulge in the forehead on the same side
•Eyes appearing to have unequal positioning
•A bald spot on flattened side (may be asymmetrical)

To learn more you may click to see :Plagiocephaly, Brachycephaly, Brachycephaly with Plagiocephaly and Scaphocephaly

Causes & Risk Factors:
A baby’s skull is very soft and can be forced to grow in different directions fairly easily. When the skull is kept in one particular position for long periods – because the baby is sleeping in a set position (such as on his back) or because muscles attached to the skull go into spasm (known as torticollis) – areas of the skull may be squashed or pulled flat. This is known as positional or deformation plagiocephaly. It generally gets better by itself over time.

Other factors that increase the risk of plagiocephaly include a multiple birth pregnancy (as the babies ‘squash together’ in the womb), prematurity, poor muscle tone and a condition known as oligohydramnios, where there’s insufficient fluid in the womb to cushion the baby.

In the US at least, plagiocephaly has become more common in recent years. Statistics show that while one in 300 healthy infants was affected in 1992, by 1999 one in 60 had the condition.

This increase is thought to be due to the Back to Sleep campaign, designed to reduce the number of sudden infant deaths (cot deaths).

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It’s possible to prevent positional plagiocephaly by changing your baby’s resting position frequently. Your baby still needs to be laid on their back to sleep, but try to alternate the position of the head and encourage them to spend time on their tummy while they’re awake and supervised.

Switch between putting them in a sloping chair, car seat or sling, or on a flat surface, so there’s no constant pressure on one area of the skull.Prolonge keeping the baby in the carseat is  very dengerous for the babies.

Plagiocephaly may also be caused by the bones of the skull joining together abnormally early. These bones normally grow together slowly so the skull expands in all directions. But if some fuse too soon (craniosynostosis), that part of the skull can’t grow in the way it should, pulling the head out of shape. This may occur in isolation, or as part of a genetic syndrome such as Apert syndrome or Crouzon syndrome.

Many vaginally delivered babies are born with an oddly shaped head caused by the pressure of passing through the birth canal. This usually corrects itself within about six weeks. But if your baby’s head hasn’t rounded out by age 6 weeks – or if you first notice that your baby has a flat spot on her skull after 6 weeks of age – it’s probably a case of positional plagiocephaly.

Plagiocephaly shows up most often in babies who are reported to be “good sleepers,” babies with unusually large heads, and babies who are born prematurely and have weak muscle tone.

Babies with torticollis can also develop a flat spot on their skull because they often sleep with their head turned to one side. Torticollis occurs when a tight or shortened muscle on one side of the neck causes the chin to tilt to the other side. Premature babies are especially prone to torticollis

Diagnosis:
Most often, your child’s doctor can make the diagnosis of positional plagiocephaly simply by examining your child’s head, without having to order lab tests or X-rays. The doctor will also note whether regular repositioning of your child’s head during sleep successfully reshapes the child’s growing skull over time, whereas craniosynostosis, on the other hand, typically worsens over time.

If there’s still some doubt, X-rays or a CT scan of the head will show your child’s doctor if the skull bones are normally separated or if they fused together too soon. If the bones aren’t fused, the doctor will probably rule out craniosynostosis and confirm that the child has positional plagiocephaly.

It’s important the type and cause of plagiocephaly are determined, as each requires different treatment. X-rays, CT scans and other tests may be needed to confirm diagnosis.

Treatment:
The condition will sometimes improve as the baby grows, but in many cases, treatment can significantly improve the shape of a baby’s head. Initially, treatment usually takes the form of reducing the pressure on the affected area through repositioning of the baby onto his or her tummy for extended periods of time throughout the day. Other treatments include repositioning the child’s head throughout the day so that the rounded side of the head is placed dependent against the mattress, repositioning cribs and other areas that infants spend time in so that they will have to look in a different direction to see their parents, or others in the room, repositioning mobiles and other toys for similar reasons, and avoiding extended time sleeping in car-seats (when not in a vehicle), bouncy seats, or other supine seating which is thought to exacerbate the problem. If the child appears to have discomfort or cries when they are repositioned, they may have a problem with the neck.  If this is unsuccessful, treatment using a cranial remoulding orthosis (baby helmet) can help to correct abnormal head shapes. These helmets are used to treat deformational plagiocephaly, brachycephaly, scaphocephaly and other head shape deformities in infants 3-18 months of age. For years, infants have been successfully treated with cranial remolding orthoses. A cranial remolding orthoses (helmet) provides painless total contact over the prominent areas of the skull and leaves voids over the flattened areas to provide a pathway for more symmetrical skull growth. Treatment generally takes 3-4 months, but varies depending on the infant’s age and severity of the cranial asymmetry.

Prognosis:
There are some beginning studies that indicate that babies with plagiocephaly tend to have learning difficulties later on in school, however these studies are still early, and do not yet represent a scientific consensus. Other more complete studies suggest that there is no evidence to suggest that plagiocephaly is harmful to brain development, vision, or hearing

Prevention:

To successfully prevent Plagiocephaly, prenatal education on skull deformation   is crucial.
Being aware of preventative measures can help reduce the chance your child will develop positional plagiocephaly. Different repositioning techniques and adequate Tummy Time are keys to prevention and also help your baby meet developmental milestones.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/plagiocephaly2.shtml
http://en.wikipedia.org/wiki/Plagiocephaly
http://www.babycenter.com/0_plagiocephaly-flat-head-syndrome_1187981.bc
http://www.cranialtech.com/index.php?option=com_content&view=article&id=73&Itemid=76
http://www.cranialtech.com/
http://www.monroeoandp.com/diagnosis_of_plagiocephaly.html

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