Plagiocephaly

Plagiocephaly, "oblique head", is a medical term or diagnosis given to a baby who has a flat spot on their head. A baby's skull is soft and can easily mold and flatten with pressure over time.

Some babies have plagiocephaly, or cranial molding, secondary to their position in the womb. Babies who have a low or transverse lie are especially prone to cranial molding while in the womb.

If you are even mildly concerned about your baby's head shape, consider a consultation with me. It is so much easier to help soothe a tense area now, than to wait to see if it will cause a problem later. CranioSacral therapy is very gentle and works with the bones and underlying membranes/soft connective tissue to promote a more typical head shape. This is done through gentle hand contact easing areas of increased tension to relax!

What causes a flat spot?

Plagiocephaly or any type of flat spot on your child's head can be caused from a variety of sources, such as:

1. Decreased Tummy Time - Tummy time is the time your baby spends lying on his or her tummy. Tummy time offsets the time your baby spends sleeping on their back, which alleviates pressure on the back of the skull. This position also strengthens your baby's shoulders and neck which helps ensure a nice head shape.

2. Back to Sleep program - The diagnosis of Plagiocephaly increased ninefold since the Back to Sleep campaign. While sleeping for hours at night, babies put pressure from the weight of their head on the back or side. The bones of the skull are soft and flatten to the surface. I support the Back to Sleep program and recommend alternating the side of the head your baby sleeps on, every 3 or 4 hours. This helps to balance out the pressures from side to side.

3. Strong head preference to one side - You may notice that your baby prefers to have his or her head turned in one direction. As your baby lies on that spot consistently over time, the soft skull begins to mold and flatten. It may be difficult for the baby to turn the head to the other side. Some babies lie directly on the back of the head and so the back of the skull is flat, others lie on one side and that side is flattened.

4. Prolonged periods of time spent in carseats - This can cause the back of the baby's head to flatten to the hardness of the carseat, especially if baby's head is tilted to one side. Additionally, the carseat limits how much your baby can move their body to readjust themselves, therefore they get "stuck" in positions. Babies should be in carseats for traveling in the car only. I know that some babies with reflux sleep better while positioned semi-upright, and the carseat appears to be a nice alternative, however, elevated sleeping positions can be done other ways, which are less risky for head flattening.

5. Multiple gestation - Twins, triplets and greater are usually fairly cramped in utero and present with head flattening or cranial molding.

6. Traumatic delivery - Forceps, vacuum, or forceful emergence from the womb often disturbs the tissues of the head and neck, causing decreased mobility and flattening.

7. Prematurity - The bones of the skull are very soft, this is especially true of premature babies, whose bones are more immature than a full term baby.

8. C-section delivery- Baby's heads are meant to "squeeze" through the walls of the vagina. The bones of the skull are designed to overlap a bit to pass through the birth canal. As the baby's head emerges from the vagina, the head reshapes fairly quickly. Babies who are born by c section do not get that initial squeeze which can affect CSF flow and head / neck function.

9. In Utero position - this doesn't just apply to big babies, even small babies sometimes don't have a lot of space to move around toward the end of your pregnancy. Many babies have a head preference to one side in the womb, these positions can cause one side to get tight, which affects all movements.

10. Being a boy - while the reasons for this are not well understood....boys are more likely to have plagiocephaly than girls.

11. Any other reason..... if you child has plagiocephaly, there is some reason for it. Let's work on it together!

Will a flat spot cause my baby to have problems?

This aspect of children's health is relatively new and has only begun to be studied by researchers. I have worked with many babies who have difficulty with latching on, sucking and swallowing efficiently, difficulty turning head side to side, have excessive crying, and lots more symptoms, when they have flat spots. It seems that babies have more trouble with draining their ears and ear infections on the same side as the flat spot, etc.

I have also worked with many, many babies who have uneven jaw position. The jaw is higher on one side than the other. The jaw is the only single, upaired bone in the body that has a bony articulation (joint) with both the right AND left sides of the body. If asymmetry (different from one side to the other) is present, the jaw will be crooked! This has implications for feeding, chewing, teeth eruption, and speech.

More importantly than focusing on problems that flat spots can cause with babies in the newborn period, let's look at how it can affect the rest of their growing and developing years. The real indicator is the the bones and soft connective tissue have alot of mobility in them at such a young age. The concern is when the bones get thicker, the connective tissue stronger, that it would get tighter over time and cause permanent deformations or strain patterns within the skull and spinal column. I would even argue that plagiocephaly is a precursor to scoliosis.

It just seems to makes sense anatomically and physiologically that having an area of tension or compression in the head cannot be helpful, so let's do something about it! The type of therapy I do is very gentle and most babies really love it! If you come to a session, I will teach you several ways to help your baby's head shape.

But what do the researchers say?

Many are reporting developmental delays associated with Plagiocephaly. This has been documented in the medical / therapy literature since around 2006. Most recently, Feb 2010, the Journal of Pediatrics looked at a group of children with plagiocephaly and highlighted that plagiocephaly is a marker of elevated risk for developmental delays. This does NOT necessarily mean that if your baby has a flat spot, he or she will have developmental delays, but there is an elevated risk. The researchers compared babies with a flat spot to ones without a flat spot and developmental differences were noted.

What can I do if my baby has a flat spot?

First and most importantly talk to your baby's pedatrician about your concern. Your pediatrician may not have noticed this spot, and additionally, flat spots can come on very quickly and may not have been present at your last doctor visit.

Secondly, call me. A telephone consultation is free and you can ask any question you want. I certainly don't have all the answers, but I have seen lots and lots of babies with flat spots. Just speaking from my clinical experience, gentle touch therapies are ALWAYS helpful for flat spots. I have always noted some improvement using craniosacral therapy, and in many cases, moderate to dramatic improvements have been noted. Even if it's difficult to understand how a very gentle touch can help your baby's head, consider calling.

Thirdly, start massaging your baby's head right now, very gently, a couple of times a day. Sometimes just touching the area will help things improve. You can gently rub clockwise circles over your baby's head, and you can "brush" your baby's hair with the palm of your hand which relaxes the head. Your baby's head is quite resiliant...remember the head is designed to be squeezed through the vagina during birth, gentle massage will NOT do any harm to your baby's head, it WILL HELP. This, I promise.