Healthy Living

The Baby With A Flat Head: How To Reverse The Rising Tide Of Plagiocephaly

Plagiocephaly
An infant with flat head syndrome, plagiocephaly, before and after treatment with a corrective headband. A Canadian study finds nearly 50 percent of two-month-olds have a flat spot on their heads. Baby Center

Although health experts are convinced that more and more infants are developing "flat head syndrome," or plagiocephaly, the actual statistics remain fuzzy. New research in Pediatrics measures the prevalence of this condition, which is marked by abnormal head symmetry, in public hospitals across Calgary, Alberta. Revised recommendations, published earlier this year in the same journal, explain how parents can prevent the deformity.

Ironically, an intervention for another newborn condition is believed to have led to the rise in flat head syndrome. In the early 1990s, the American Academy of Pediatrics advised that healthy infants be placed in the supine position — on their backs — while sleeping to prevent sudden infant death syndrome (SIDS).

SIDS is the leading cause of newborn mortality, according to the U.S. Centers for Disease Control and Prevention (CDC). While there are many risk factors for the mysterious condition, including genetics, gender, race, and bacterial infections, sleeping position has long been thought to be a major contributor to its occurrence.

The American Academy of Pediatrics' advice motivated the eventual creation of the "Back To Sleep" campaign, which was adopted by several countries, including Canada. The program is credited with decreasing the occurrence of SIDS by more than 50 percent.

But individual doctors have noticed a concomitant elevation in flat head syndrome, and nursing experts in Calgary decided to measure the extent of the problem. They visited four community health centers across the city and observed how many infants between seven to 12 weeks of age had asymmetrical heads.

"More than 95% of infants in Calgary attend these clinics to receive their childhood immunizations," wrote the authors, who were led by Dr. Aliyah Mawji, a professor of nursing at Mount Royal University. The study's sample population should be somewhat representative of the metropolitan area.

Out of the 440 infants examined, nearly half — 47 percent — had head flattening, with a tendency for the problem to occur on the right side.

"In our study, right-sided flattening was present in 63.8% of plagiocephaly cases, whereas 36.2% were observed to have left-sided flattening," wrote the Mawji and colleagues, who concluded that the best intervention would involve parental education on the subject.

Instructions for these classes would probably include a separate set of guidelines put forth by the American Academy of Pediatrics in January. Three main points emerge from this report as to how physicans can best education new parents:

1. While awake, the child should spend a certain amount of time in prone positioning, or "tummy time."

2. Beginning at birth while the baby is sleeping in a supine manner, the head position of the new bambino/bambina should be rotated (from left to right) at a periodic interval.

3. Prolonged time in a car safety seat and swings should be avoided.

Debtate remains over whether or not plagiocephaly is detrimental to learning ability and cognition; however, permanent disfigurement can lead to embarassment and bullying when a child grows up. Luckily, the condition is often reversibe, and there are many ways to treat flat head syndrome, which is more prevalent in premature babies. These remedies include special helmets or headbands that reshape the cranium.

Example
Example of a cranial remolding band (helmet)

Sources: Seattle Children's Hospital. Positional Plagiocephaly.

Aliyah Mawji A, Vollman AR, Jennifer Hatfield J, McNeil DA, Sauvé R. The Incidence of Positional Plagiocephaly: A Cohort Study. Pediatrics. 2013.

Laughlin J, Luerssen TG, Dias MS, the Committee on Practice and Ambulatory Medicine, Section on Neurological Surgery. Prevention and Management of Positional Skull Deformities in Infants. Pediatrics. 2013.

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