Plagiocephaly, also known as flat head syndrome, is a condition characterized by an asymmetrical distortion of the skull. It is characterized by a flat spot on the back or one side of the head caused by remaining in a supine position for prolonged periods. Plagiocephaly is a diagonal asymmetry across the head shape. Often it is a flattening which is to one side at the back of the head and there is often some facial asymmetry. Plagiocephaly divides into two groups: synostotic plagiocephaly, with one or more fused cranial sutures, and nonsynostotic plagiocephaly. Surgical treatment of these groups includes the deference method; however, the treatment of deformational plagiocephaly is controversial. Brachycephaly describes a very wide head shape with a flattening across the whole back of the head.
Causes
Slight plagiocephaly is routinely diagnosed at birth and may be the result of a restrictive intrauterine environment giving a "diamond" shaped head when seen from above. If there is premature union of skull bones, this is more properly called craniosynostosis. The incidence of plagiocephaly has increased dramatically since the advent of anti-sudden infant death syndrome recommendations for parents to keep their babies on their backs. Data also suggest that the rates of plagiocephaly is higher among twins and multiple births, premature babies, babies who were positioned in the breech position or back-to-back, as well as babies born after a prolonged labour.
Diagnosis
A developmental and physical assessment performed by a physician or a pediatric specialist is recommended. Often imaging is obtained if the diagnosis is questionable to see if the baby's sutures are present or not. If the sutures are not present, craniosynostosis may be ruled into question.
Prevention
Prevention methods include carrying the infant and giving the infant time to play on their stomach, which may prevent the baby from progressing into moderate or severe plagiocephaly. Letting babies crawl may also prove to be crucial in preventing plagiocephaly as it strengthens babies' spine and neck muscles. Crawling also boosts gross and fine motor skills, balance, hand-eye-coordination and overall strength.
Treatment
The condition may improve to some extent as the baby grows, but in some cases, home treatment or physical therapy treatment can improve the shape of a baby’s head. Early interventions are of importance to reduce the severity of the degree of the plagiocephaly. Diagnosis is most commonly determined through clinical examination. In order to assess the severity of the condition and determine the best course of treatment, practitioners often use the Plagiocephaly Severity Scale. This is a scale that can help practitioners evaluate the condition in a standardized way. The course of treatment is typically based on the age of the child when the diagnosis is made in conjunction with the severity of the diagnosis. If a diagnosis of mild to moderate plagiocephaly occurs before four months of age, repositioning therapy may be helpful. If the diagnosis is determined to be severe, practitioners will likely prescribe a cranial molding orthosis, which has the best results when prescribed between five to six months of age.
Repositioning
Initially, treatment usually takes the form of reducing the pressure on the affected area through repositioning of the baby onto their abdomen for extended periods of time throughout the day. This may include repositioning the child's head throughout the day so that the rounded side of the head is placed against the mattress, re-positioning 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, re-positioning mobiles and other toys for similar reasons, and avoiding extended time sleeping in car-seats, 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 re-positioned, a neck problem should be ruled out.
Helmets
High quality evidence is lacking for cranial remolding orthosis for the positional condition and use for this purpose is controversial. If conservative treatment is unsuccessful, helmets may 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 by gently allowing the head shape to grow back into a normal shape. This type of treatment has been used for severe deformations.
Prognosis
Preliminary research indicates that some babies with plagiocephaly may comprise a high-risk group for developmental difficulties. Plagiocephaly is associated with motor and language developmental delays. While developmental delay is more commonplace among babies with plagiocephaly, it cannot be inferred that plagiocephaly is the cause of the delay.
Etymology
Ancient Greek πλάγιος "oblique, slanting," from PIE plag- "flat, spread," from *plak, and cephal-Modern Latin "head, skull, brain," together means “flat head”.
