What is it?
Plagiocephaly is a deformity of the infant’s skull giving it an asymmetrical shape, often referred to as the “flat head syndrome”. In the vast majority of cases, it is a benign abnormality that resolves before the age of two years and results from the supine position on the baby’s back. But, much more rarely, this asymmetry is the result of the premature welding of one or more cranial sutures, a craniosynostosis, which may require a surgical operation.
Symptoms of Plagiocephaly
Positional plagiocephaly is characterized by a flattening of the occiput (back of the skull) on the side corresponding to the orientation of the head during sleep, hence the expression flat head syndrome. The infant’s head then takes the form of a parallelogram. A study whose results are relayed by the Canadian Pediatric Society shows that 19.7% of infants exhibit positional plagiocephaly at four months of age and then only 3.3% at 24 months. When craniosynostosis is involved, skull deformity varies depending on the type of craniosynostosis and the sutures it affects.
The origins of the disease
Positional plagiocephaly is by far the most common cause of plagiocephaly. Its frequency of occurrence has exploded in the United States and Europe since the 90s, so much so that the press, like the doctors, speaks of an “epidemic of flat skulls”. It is now proven that the origin of this epidemic is the “Back to Sleep ” campaign launched in the early 1990s by the American Academy of Pediatrics to fight sudden infant death, which advised parents to sleep infant on the back exclusively during the first year of life. It is important to underline that this benign epidemic does not put in question the “dodo on the back” which makes it possible to limit the risk of sudden death.
Craniosynostosis is a much rarer cause of cranial asymmetry than positional plagiocephaly. It causes a premature weld of the bones of the skull of the baby, which can disrupt the good development of his brain. This deficiency of congenital ossification is a simple anomaly isolated in the vast majority of cases, but craniosynostosis can be associated with a cranial syndrome, resulting from a genetic abnormality (the mutation of the FGFR gene), such as Crouzon syndromes and Apert.
Risk factors for Plagiocephaly
In addition to the horizontal position on the back (supine) to sleep and sleeping on the same side, other risk factors for plagiocephaly are clearly identified. Boys are more affected than girls, with nearly 3/4 of infants with positional plagiocephaly being boys. This is explained by their lower activity in the first months of life, with periods of awakening on the stomach not often enough (less than three times a day). Researchers have also identified as a risk factor the role of senior in the family, torticollis which limits the rotation of the neck, as well as the exclusive feeding of the bottle.
Prevention and treatment of Plagiocephaly
The risk of occurrence of cranial deformities can be reduced by multiplying the positions of the infant and the orientations of his head. During the sleep phase, while lying down on the doc (in the supine position), when the baby shows a clear preference for the same side, the technique to encourage him to turn his head is to change the orientation of the baby in the alternate bed each day, to the head or foot of the bed. Recall again that the supine allows limiting the risk of sudden death and should not be questioned because of a benign affection often resorbed at the age of two years!
During awake phases, the baby should be placed in various positions and placed on the stomach (in the prone position) for about a quarter of an hour several times a day. This position helps the development of the cervical musculature.
Physiotherapy treatment including developmental stimulation exercises can complement these measures. It is particularly recommended when a torticollis prevents the infant from turning his head.
In cases where head injury is severe, orthotic treatment is provided by wearing a molding helmet for infants up to a maximum of eight months of age. However, it can cause discomfort such as skin irritation.
Surgery is only necessary in cases of craniosynostosis.