Hey doc, why is my baby’s head shaped funny? I can’t recall how many times I have been asked that question by a parent. Often after a baby is born their endless possibilities. head is not totally equal from side to side. This can be due to the baby’s position before the delivery. It is something I always described as a packaging issue. In fact it is seen most often during multiple births which confirms that some of this may be due to restricted movement while the baby or babies are growing in utero (inside the mother). The fancy medical term for this issue is deformational plagiocephaly.
While we have always had some patients who have had significant plagiocephaly many have had milder versions that over the first 6-8 months of life improves. In fact about one in 300 births has some degree of head asymetry but only about 0.4 to 1 of 1000 actually have a serious issue.
Why is it changing?
In 1992 the American Academy of Pediatrics recommended that parents place their babies on their backs or sides for sleeping in order to prevent Sudden Infant Death Syndrome (SIDS). This recommendation has resulted in a 40% reduction of deaths related to SIDS worldwide. So this intervention clearly seems to work. However as a result of these positioning techniques a baby’s head may become flatter in one area and change the shape of the head.
What can we do?
Since the infant’s head is rapidly growing during the first year of life and the fastest rate is between 4-7 months, we recommend increased supervised belly time to allow the head to grow more freely and change shape and physical therapy and home exercise program. This often requires frequent changes in position. After about 7 months of age babies tend to be more spontaneous in their movements and freely turn their own heads.
This is suitable for most children.
However sometimes based on the degree of asymmetry your doctor may recommend using a head shaping device called a cranial molding orthosis. These actually come in 2 types: a head band or a helmet.
How do we know if we need it?
There are specific measurements we take in the doctor’s office to guide us before making this intervention. Since the head is growing the fastest between 4 and 7 months we usually use the orthosis/helmet in this period in order to harness this natural pattern. Most infants will need to use the device for 3-6 months up to 23 hours a day!
Are there any dangers?
First this is not meant to be placed on your child’s head and ignored. They need frequent monitoring to assure that it is not causing any skin breakdown due to the pressure. Also,while the literature says there is no pain associated with the use of the device, there may be discomfort as with any splint orthosis used elsewhere. Most importantly it only works when used, and the recommendation is for 23 hours a day.
FOR FURTHER INFORMATION:
APTA Section on Pediatrics
1111 North Fairfax Street
Alexandria, VA 22314
800-999-2782, ext 3254
Pediatrics@Apta.org
Jeff Greenberg is a Manhattan based artist that has developed the Encaustic Wax Heart Series to raise funds for the Staten Island Heart Society.
This is a 501c3 local not for profit group that has promoted healthy heart awareness and the distribution of defibrillators throughout NYC.
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By Dr. Jack B. D’Angelo
