My baby has a flat head- Plagiocephaly

What is Plagiocephaly and how can you prevent or treat it with exercises and positions at home?

I felt self conscious being a physiotherapist, who should know how to prevent plagiocephaly, that I had a baby daughter with it. I was doing all the right positioning yet she still had it.

The physiotherapist and paediatrician we were seeing for her hips and feet made note of her flattened head and made the physiotherapy recommendations to help fix it. These exercises I will detail below I was already doing.

I then worked out that I was not in the wrong and that she had developed the plagiocephaly in utero with her head most likely up against the wall of my uterus because the flattened part was too high on her skull to be due to lying on it. If developed in utero it can also be due to low amniotic fluid, multiple babies or increased uterine or abdominal tone. Mine was probably the latter. ;)

Plagiocephaly means flattened skull and has become more common with the SIDS recommendation for sleeping only on the back. The babies thus spend too much time in one position and their skull which is soft cartilage at this stage, not bone gets squashed out of position with the weight. If left unaddressed the skull can be permanently disfigured when the skull bone hardens. It is only purely aesthetic that it is addressed rather than causing any pathological damage.

Another reason for plagiocephaly is torticollis, when your baby doesn’t have full range of neck movement due to muscle tightness which makes it hard for your baby to lay her head in different positions. Physiotherapists can help you treat torticollis. Please see our blog on My baby is making my boobs lopsided for more information on this.

“Plagiocephaly is more common with the SIDS recommendation for sleeping only on their back...””

The best way to treat plagiocephaly is through physiotherapy exercises which a physio can teach you. During the day when they are not sleeping try to minimise the time lying on their backs. Have plenty of tummy time and side lying time with supervision. If lying on their back place toys on alternating side of them so that they tilt their head to either side dispersing the pressure through their skull during the day. Place them at either end of the cot so that they are looking to different sides too. Lastly hold your baby on alternate sides (for short periods when standing so you don't hurt your back with the asymmetrical hold).

“have plenty of tummy time and side lying time with supervision...”

If your child gets plagiocephaly and these conservative measures do not work, special customised helmets can be made so that pressure is not placed on their skulls and the flattened skull can regain its shape. Best results are seen if the helmet is worn when 5-6 months. Applied after this gives significantly worse results. Early treatment with physiotherapy and helmet therapy in severe cases is essential for best results. https://www.ncbi.nlm.nih.gov/pubmed/21788840 See your doctor in regards to this.

Misaki’s flattened head has now resolved with the growing skull and malleable fontanelles (the suture lines that divide the skull bones) which stay soft for the baby’s first year to allow the brain and skull to grow unimpeded.

Summary

Plagiocephaly means a flattened skull which occurs with too much time lying on their back.

Plagiocephally can be prevented and treated by positioning your baby in various positions during the day and different ends of the cot when sleeping.

Physiotherapy can help with exercises and torticollis if that is contributing to the Plagiocephaly.

Melli Tilbrook is a Physiotherapist based at Adelaide Physiotherapy and Pilates Studio, Beulah Park.