Plagiocephaly

Plagiocephaly describes an asymmetrical, flattening of the baby's head. The most common type of plagiocephaly, positional plagiocephaly, is due to prolonged periods of external forces applied to a baby’s soft head. There are two main types of positional plagiocephaly:

1. Lateral Plagiocephaly
   • Asymmetrical, posterior flatenning on one side of the occiput (back side of the head)
   • Occipital flatenning is often present with bossing (increased rounding) on the other side of the occiput and/or with frontal bone bossing on the same side of the posterior flatenning
   • It is often viewed as a "parallelogram shaped" head
2. Brachycephaly
   • Flatenning across the entire occiput (back side of the head)
   • The head appears wider and the head may also appear shorter in height
   • Bulging or bumps above the ears
   • Face may appear smaller relative to head size

Congenital Muscular Torticollis is the most common medical condition associated with plagiocephaly

• Research indicates that >80% of infants with plagiocephaly have some degree of CMT
• Research suggests the fetus is constrained in-utero predisposing them to a positional head preference after birth

In-Utero Constraint

• Small maternal pelvis
• Abnormal uterine structure (e.g., fibroid tumor)
• Large fetus
• Multiples birth (e.g., twins, triplets)
  • Twin A or Triplet A is most often affected
• Low aminiotic aluid (oligohydramnios) or Increased amniotic fluid (polyhydramnios)
• Increased abdominal or uterine muscle tone

Other Causes

• Excessive time place in supine or reclined position
  • Babies spend >700 hours on their backs within the first 2 months of life in a crib, bouncey seat, swing, play gym, or car seat
  • Caregivers place them in the same position
• Prematurity
  • Softer skull is more susecptible to prolonged external forces making it easier to mishapen
• Lack of Tummy Time Practice
• Neurological or Cervical Spinal Defects
  • These are rare

• Congenital Muscular Torticollis (CMT) resulting in positional head preference of a tilt and/or turn to one side
• Prolonged, cumulative exposure to being placed on his/her back (supine position) or a reclined position
• First born babies
• Multiples Birth (e.g., twins, triplets)
• Nonvertex presentation for delivery (e.g., breech, sunny-side, side)

• Plagiocephaly is not the same as craniosynostosis.
• Craniosynostosis (kray-nee-o-sin-os-TOE-sis) is a congenital deformity in which there is early (premature) closure of one or more of the fibrous joints between the bones of your baby's skull. These joints are referred to as sutures. Premature fusion of the cranial sutures impairs skull growth necessary for rapid brain growth and development during the first year of your baby's life.
• Craniofacial asymmetry and abnormal head shape develop because the skull can not grow in a typical pattern. In some cases, craniosynostosis results in increased intracranial pressure causing visual impairments, irritability, difficulty sleeping, difficulty eating, and mental impairments.
• It is relatively rare, occuring in only 1 in every 2,000 births. In the majority of the cases, one suture is affected.
• Craniosynostosis typically occurs as an isolated condition but it can be associated with syndromes such as Crouzon, Apert, Jackson-Weiss, Muenke, and Pfeiffer.
• Parents should consult their pediatrician, a pediatric neurosurgeon, or a craniofacial surgeon immediately. Surgical intervention is required to correct craniosynostosis
• Scaphocephaly or Dolichocephaly is the most common form of craniosynostosis due to premature fusing of the sagittal suture. The head shape appears longer and narrower than a typically developing head. The sides of head appear flattened.