This is a problem where one side of the baby’s head is flat and the most likely cause is the baby lying down on the bed with one side of the head on the bed preferentially. Over time in the first few months of life, that side of the baby’s skull may become noticeably misshapen. In more severe cases, when looking at a baby’s head from above, one ear may be pushed forward. Also from above, the skull may be shaped like a parallelogram instead of a more symmetric shape.
What causes this?
Plagiocephaly became much more common after it was recommended that newborns sleep on their backs to decrease the risk of sudden infant death syndrome (SIDS). In 1991, it was found that by placing sleeping babies on their backs, the number of babies dying in their sleep was cut in half. A baby with a misshapened head due to plagiocephaly needs to be differentiated from another important cause known as craniosynostosis. This is a rare problem that is caused when joints between the bones in the skull (suture lines) which should be open are fused or closed. This causes the skull to grow in the wrong direction. Craniosynostosis can be distinguished from plagiocephaly both by a doctor examining the baby and taking an x-ray of the skull. Plagiocephaly is more common in premature newborns due to poor head control and a softer, thinner skull.
What can be done about this?
Parents can employ strategies to prevent and improve plagiocephaly. When one holds the baby, then the skull is not being molded by a flat surface. Holding your baby is a good thing! By rotating the direction your baby lays in the crib, he or she will be encouraged to hold his or her head differently to observe the world around them. An example would be to change the direction your baby’s feet point to the opposite direction every week. Changing the orientation of the crib in the bedroom so a different side is facing the wall can also accomplish this. These maneuvers will allow a different part of the skull to be dependent against a flat surface. Over time, the baby will develop stronger muscles to control the head and neck better and not have a dependent, floppy head on a flat surface of the bed. In some instances, a molding helmet may be needed to correct this problem.
Two important take-home points:
#1. Infants need to sleep on their backs to prevent sudden infant death syndrome.
#2. Hold your baby as much as possible! Cuddle time is very helpful to prevent and improve plagiocephaly not to mention other benefits such as parent-infant bonding. Of course, any questions you have about this issue should be directed to your pediatrician.
By. Dr. John Galgani, Esse Health Pediatrician
