Charl Stenger from Mediclinic Orthotic Services sheds some light on a very common issue.
Parents are naturally concerned about unusual flat spots on their infant’s head. These concerns are valid and need more understanding. The push to put babies to sleep on their back to reduce the risk of sudden infant death syndrome (SIDS) has been associated with a decrease in the incidence of SIDS. Unfortunately this has led to an increase in the number of babies suffering from head shape abnormalities. Although associated with some risk of skull deformity; healthy young infants should always be placed down for sleep on their backs. This has raised the need for vigilance and education on the part of healthcare specialists, parents and those caring for young infants. It’s a misconception that these mild to severe deformities resolve on their own, and early intervention and treatment is fundamental to prevent irreversible abnormalities.
The most prevalent head abnormality is deformational plagiocephaly. Here the infant’s head appears misshapen or asymmetrical immediately after birth, or develop in the first few months of life. Deformational Brachycephally is present when the entire back of the infant’s head is flat and the head is very wide. Deformational Scaphocephaly is when the head is elongated that is excessively long for its width.
The plasticity of the newborn’s skull makes it susceptible to external pressures in the womb, during the birth process and after birth. The immobility of newborns and any positional neck preference can predispose infants to skull deformities. The abnormal shape may persist or occur if the infant spends most of the day on the back against the hard surface of infant carriers and holding devices. Usually, the infant’s head becomes more symmetrical and better proportioned within about six weeks after birth. However, the flattened areas may not resolve if the infant’s head continuously rests in the same position. This is particularly problematic if the infant has neck muscle tightness (Torticollis).
Primarily parents need not worry and should discuss any possible visual abnormalities with their pediatrician. The American Academy of Pediatrics (AAP) suggests physicians evaluate the infant’s head at each visit from the top, sides, front and back. This might include other measurements called anthropometric data. The assessment includes not only the flatness of the back of the head, but possible ear shift and cheek and jaw deformity. This data is used to determine the severity of the condition. The AAP also recommends physicians talk to families about how to move the infant into a lot of different positions during the day, and stress the importance of “tummy time” whenever the infant is awake and supervised. Tummy time is not only a good way to take pressure off the flattened areas, it also builds strong neck and trunk muscles and will help the infant learn to roll and sit, as they grow.
The most important factor to help prevent and reduce the effects of deformational plagiocephaly is timely diagnosis and protocol referenced treatment. This includes comprehensive and timely parent education especially in high risk cases for example multiple and pre term births. Infants three month or younger with Torticollis, developmental delay or a head abnormality benefit greatly from pediatric physiotherapy. All babies benefit from frequent changes in body and head positions incorporated into a tummy time home program and limited time in carriers and positioning devices.
Mild to moderate deformity that persists past 6 month of age needs further intervention. This is important as treatment becomes less affective after 12 months of age, though some correction is possible to 18 months. Use of a STAR cranial remolding orthosis may be indicated. The STAR orthosis is a plastic and foam custom molded device designed to gently correct the infant’s head shape.
For more information call Mediclinic Beach Road at 04 379 7711, email firstname.lastname@example.org or visit www.starbandkids.com.