Plagiocephaly

When a baby is born with an asymmetrical head it is called plagiocephaly, from the Greek “plagios” meaning oblique and “kephale” meaning head.  A true plagiocephalic head will resemble a parallelogram when viewed from above. 

Newborn skulls are cartilaginous and membranous which allows them to be soft and malleable through the birth process. Birth strains usually resolve quickly or by six weeks post birth.  “As the twig is bent so shall the tree incline” is a well known phrase from the founder of osteopathy, Dr. Andrew Taylor Still. Early osteopathic treatment is recommended to address cranial and facial strains related to plagiocephaly. When left untreated, plagiocephaly may contribute to postural imbalances and delays in early milestones,

There are two types of plagiocephaly; primary and secondary.  Primary plagiocephaly is present at birth and may be related to the following factors:

Through pregnancy:

• abnormal uterine positioning or strong moulding forces in the uterus 

• Primiparity, first child

• Twin pregnancies, less space

• Intrauterine constraint

• Low amniotic fluid or premature engagement of the head and pelvis

• Premature baby, the skull is still very soft and malleable

• Torticollis related structural anomalies, for example congenital fusion of cervical vertebrae.

The birth process:

• A difficult or lengthy labour

• Assisted delivery (especially if ventouse or forceps used)

Secondary plagiocephaly appears several weeks to months after birth. Causes include: 

• Torticollis where plagiocephaly develops secondary to torticollis.

• Dysfunction of C1 causing fixation of the head

• Positional flattening, baby spends too much time lying on their back

• Restricted position of newborns

ON EXAMINATION 

You may notice a flat spot at the back or side of your baby’s head as well as bulging, called “bossing” at the front of their head on the same side.  Your baby may have difficulty turning their neck to one side, prefers resting their head in one position or to feed from one breast. You may notice you baby’s eyes and ears are not symmetrical. 
Your osteopath can inspect and palpate (feel) the cranial bones, suture and fontanelles to diagnose plagiocephaly. 

OSTEOPATHIC TREATMENT 

Early and frequent osteopathic treatment is important to treat any intraosseous restrictions and strain patterns of the cranial base and resolve any membranous and fluid strains. Treatment of the cervical spine is indicated if torticollis is related. Dr. Michelle Sherriff utilises a very gentle form of osteopathic treatment for babies called Biodynamic Osteopathy in the Cranial Field. This type of treatment allows your baby to come to a point of stillness, allowing an unwinding and rebalancing of their system.

WHAT YOU CAN DO

• Make an appointment with your osteopath for early and regular treatment

• Face Time, when you baby is awake play with them face to face

• Tummy Time, place them lying down on their tummy (when awake) or on their side from from 1-2 weeks of age.

• Encourage your baby to turn their head to the restricted side with toys, rattles or positioning cot so your baby turns to look at you.

• Vary the position of your baby’s head when putting them down to sleep to avoid the flat spot

• To reduce risk of SIDS babies must always be placed on their back to sleep

• A helmet may be an option if the deformation is moderate or severe and persists beyond 6 months.

• A more serious condition called craniosynostosis must always be excluded before plagiocephaly is treated conservatively