Plagiocephaly

Plagiocephaly: how do you say it, what is it, what causes it, and how do I fix it?

If you have a baby with a flat head (plagiocephaly) and live in Scottsdale, Phoenix or Tempe, AZ, you're in the right place! Not only is this article is for you, but at Moving & Grooving Pediatric Physical Therapy, we specialize in plagiocephaly!

First things first: how do I pronounce plagiocephaly? Plagiocephaly is pronounced like play-gee-oh-sef-uh-lee.

What is plagiocephaly? Plagiocephaly is a condition in which the skull is not symmetrical and/ or round as is expected in normal physiological development. There are subtypes of plagiocephaly, including brachycephaly (brackee-sef-uh-lee), where the back of the head is nearly flat, and scaphocephaly (skaf-ee-sef-uh-lee), where the head is more long and oval-like than typical. Standard plagiocephly can be identified as more of a parallelogram-like shape, where if the back left corner is indented, the front left corner is protruding, or there can be other random flat sports or excessively rounded spots. Please note that there are other conditions that may be misdiagnosed as plagiocephaly, so it is best to have a professional assess this, to ensure a more serious condition is not missed.

I'm noticing that my baby has a flat spot; does this mean they also have a flat head? How can I tell if my baby has plagiocephaly?

You can assess your baby's head shape from a bird's eye view... You can do this by laying them down on their back and taking a photo of the top of their head in reference to the floor and ceiling, or you can sit them up and take it from directly above. You may also be able to notice this if they have brachycephaly or scaphocephaly by taking a picture from the side. You can see examples here.

Did I cause this? Is it my fault? Am I a bad mom/ am I a bad dad?

What causes a flat head in babies is not such a simple question. Plagiocephaly can develop for a variety of reasons, and many are out of your control. So no, you are not a bad parent! And also, many of us only notice the best in our children as opposed to looking at aspects that may not be perfect. If a baby has higher or lower muscle tone and have a difficult time moving their head because of this, this presents as an increased risk. If your baby has torticollis and/ or limited neck mobility, this often goes hand in hand with plagiocephaly, as they are unable to unweight parts of their head that are in contact with the ground beneath them.

One thing you can do immediately to reduce the degree of plagiocephaly is to increase the time your baby spends on their side or their tummy as opposed to laying on their back. Research has shown that once babies spend at least 1 hour per day on their tummy, it is sufficient to offset the time they spend on their back when sleeping. We always recommend repositioning, AKA tummy time, to fix a flat head; spending more time on their tummy, if your child is less than a few months old. If you've tried this for a few weeks and don't see an improvement, or you’re not sure how to incorporate more repositioning or how to make sidelying play or tummy time more enjoyable, we cover this in our pediatric physical therapy evaluation for flat head treatment.

Does my baby need a helmet (DOC band) to fix their flat head?

Whether your child would require helmet therapy depends on a few factors, such as severity and location of asymmetry that the plagiocephaly has affected the most. DOC bands are most effective when started between 4 months and 6 months of age (adjusted). Repositioning and physical therapy are the first recommendations to intervene. If physical therapy isn’t effective at improving your child’s head shape, DOC bands are extremely effective at this between the ages of 4-12 months of age.

What happens if it isn’t fixed?

Plagiocephaly isn’t a purely cosmetic concern. It is associated with jaw malalignment and TMJ pain (affecting eating), as well as potential scoliosis and breathing difficulties due to the spinal alignment.

It can lead to decreased coverage of the lower part of the brain when wearing a helmet, a standard helmet or hat not covering the head, which affects protection of the brainstem, which controls basic functions like breathing. Imagine your child being a star athlete, but are delayed playing because they can’t find a helmet that fits, or they need a new custom fitted helmet every season they play this sport.

Alternatively, it can lead to facial asymmetry, differences in eye size or ear height. Since we live in one of the sunniest cities in America, Phoenix, we are constantly told to protect our eyes from the sun. Imagine that sunglasses won’t stay on your child’s ear and face because their ears are misaligned, or the glasses can’t rest naturally on the bridge of your child’s nose? This can lead to damaged retinas of their eyes and sunburn or skin damage on their face.

So if you'd like to avoid these associated side effects, be sure to start plagiocephaly treatment in Phoenix, AZ immediately with a skilled pediatric physical or occupational therapist. If you have any questions about how to get help for your child and you are in Scottsdale, AZ or any surrounding areas, please schedule a pediatric physical therapy evaluation with us right away.