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Craniofacial Conditions

 

Deformational Plagiocephaly

What is deformational plagiocephaly?

This is a condition in which a baby's head becomes flat on one side. If the condition is more obvious from the front, it is called deformational frontal plagiocephaly (DFP); if it involves the back of the head, it is called deformational posterior plagiocephaly (DPP). In some children, the condition affects the facial bones, while in others it does not.

What do children with the condition look like?

In children with deformational frontal plagiocephaly, one side of the forehead is flat, sometimes the cheek and lower jaw are small, an ear is positioned farther back, and the eyelid opening may look smaller. All of these characteristics occur on the same side as the flattened forehead. About two-thirds of infants with DFP have a tilt of the head toward the shoulder on the affected side due to a tightness of the neck muscles called torticollis.

In children with deformational posterior plagiocephaly, the back of the head is flat on one side, the ear on that side is further forward than normal, and there is often a minor flattening of the forehead on the opposite side. DPP can also be bilateral, occurring on both sides.

How is deformational plagiocephaly diagnosed?

It is usually diagnosed during a physical examination by a pediatrician or neonatologist (a doctor who specializes in newborn health). Sometimes, X-rays of the skull are needed to confirm the diagnosis. X-rays also provide information about whether another condition is causing the flattening of the head. One such problem can be the premature closing of the space between bones of the head in the forehead or, rarely, at the back of the head. This abnormal closure is known as synostotic plagiocephaly.

It is imperative that a correct diagnosis is made because synostotic plagiocephaly requires an operation to be corrected, while deformational plagiocephaly usually corrects itself as a child grows.

How common is deformational plagiocephaly?

It occurs in five to 45 percent of otherwise healthy newborns. Of the two forms of the condition, DFP was seen more commonly prior to 1991. Since then, DPP has become the more common variety, often occurring in combination with DFP. In 1991, pediatricians began recommending that infants be placed on their backs during sleep to minimize the chance of Sudden Infant Death Syndrome (SIDS). This measure has been successful in reducing SIDS, but it has also led to a dramatic rise in DPP.

What causes deformational plagiocephaly?

Cranial flattening is thought to arise when tissues or liquids in the uterus press against the soft, developing bones of a baby's head. It can also occur if a baby descends too early into the pelvis prior to birth. It is more common in twins than in single births. After birth, it is likely that the condition is related to the baby's lying with the head turned only to one side, because of weakness of the neck muscles. For unknown reasons, in more than two-thirds of all infants with deformational plagiocephaly, there is DPP of the right rear of the head, and DFP of the left forehead.

Do children with the condition have other physical abnormalities?

Sometimes. The infant may have deformational abnormalities such as a clubfoot, protruding ears, hip dislocation, and curvature of the spine. These conditions can be diagnosed by your pediatrician.

What is the best treatment for my child?

Whether the problem is DFP or DPP, the most important precaution is to position your child so that the flat area of the head is off the mattress when sleeping. You should also position your child's toys and even the crib itself to discourage your child from lying on the flat side of his or her head.

A baby with DPP should not sleep on the flat side of the back of the head. After about four months of age, or when a child can comfortably lift and turn the head, it may be permissible to position your baby on the stomach for naps. Ask your care team for assistance in determining the right time for your baby.

Infants with torticollis improve with physical therapy. Usually, only one visit with a physical therapist is needed for parents to learn the special exercises that stretch the baby's tight neck muscle. This will provide more flexibility to the baby's movements.

For an infant with minor to moderate deformational plagiocephaly, the recommended treatment is positioning the baby not to lie on the flattened area of the head.

For an infant with more severe flattening, a custom-made helmet can help ensure that the head grows normally. The helmet should be worn most of the day, and always while sleeping. The helmet, which does not hurt the child, works by holding the bulged area while leaving space for outward expansion of the flattened area as the rest of the head catches up. Some parents describe the helmet as a "retainer" or "braces" for the growing head.

Positioning, physical therapy, and helmeting (if necessary) should usually continue for the first year of your child's life. The head grows rapidly during this time, and these measures provide the best chance for complete correction of deformational plagiocephaly.

Recommended Reading

  • "Information for Parents"
  • Booklets by John B. Mulliken, M.D., on Deformational Plagiocephaly.
  • Children's Hospital Boston,
  • Craniofacial Centre, 300 Longwood Avenue, Boston, MA 02115
  • Download this PDF

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