Molding helmet therapy for positional plagiocephaly (in consultation with Orthotics)

Plagiocephaly is a condition in which the head of an infant becomes mishapened, usually becomes of flattening of one side of the back of the head (posterior plagiocephaly). It is easiest to see the flattening by looking down on the top of your child's head. In addition to having a flat head, you may also be able to see that his ears don't line up.

Although rarely associated with craniosynostosis, or a premature closing of the lambdoid sutures of the skull, it is most commonly caused by the position in which the baby spends the most of his time. Recently, the AAP recommendation that all newborns and infants sleep on their back has probably lead to the rise in cases in recent years. The Back To Sleep program has lead to a large decrease in the number of children that die from Sudden Infant Death Syndrome (SIDS), so it is recommended that parents continue to place their infants to sleep on their back, but it is best to vary the position that they sleep in to prevent flattening.

It is important that your child with a flat head be examined by his Pediatrician to make sure that he doesn't have craniosynostosis, a rare, but more serious condition that usually requires surgery to correct. Your doctor can usually tell by examining your child if the flat head is caused by positional plagiocephaly or by closure of a suture. Some clues on examination that would favor a diagnosis of a positional deformity include that your child's ear on that side of his head will be displaced away from the area of flattening. Children with posterior flattening caused by craniosynostosis will have the ear displaced toward the area of flattening. Also, with positional flattening, the forehead will be prominent or have bossing (meaning it will be bulging outwards) on the same side of the skull that is flattened in the back. If the diagnosis is uncertain, then your doctor may order skull x-rays or a CT scan or MRI to check and see if the sutures are still open.

Children with positional plagiocephaly are usually first treated with recommendations to keep them from lying on the flattened side of their head. Sometimes moving his crib so that it is facing another direction, or moving his toys or mobile will encourage him to turn his head. You should also try and keep him on his stomach for 'tummy time' during the day when he is supervised.

Mild deformities will usually correct on their own with these measures. If there is no improvement in a few months, then children with positional plagiocephaly may need to treatment with a molding helmet or head band, such as the Dynamic Orthotic Cranioplasty Band (DOC band) that can help to reshape the head. These devices are worn for most of the day to mold the skull's shape back to normal. The DOC band and molding helmets work best if used during your child's first year of life.

Some children with congenital torticollis, a condition in which the muscles of one side of the neck are tight and keep the head turned to that side, are prone to get a flat head. In addition to the treatments described above, they may also benefit from physical therapy. Premature babies are also more prone to getting a flat head from positional molding of their skull.

It is important to remember that having a flat head caused by a positional deformity is a cosmetic problem, and the brain continues to grow normally. Your child will not have any disabilities from this condition and if treatment is begun early, usually before six months of age, the results will be very good, with a normal or near-normal head shape.

Diagnosis and Treatment

Most often doctors can make the diagnosis of positional plagiocephaly simply by examining the child's head, without lab tests or X-rays. Doctors will also note whether regular repositioning of the child's head during sleep -  the most common treatment for positional plagiocephaly - successfully reshapes the child's growing skull over time (true craniosynostosis typically worsens over time).

If there is still some doubt, X-rays or CT scan of the head will show the doctor if the skull sutures are open or fused. If they are open, the doctor will probably confirm the positional plagiocephaly diagnosis and rule out craniosynostosis.

Treatment for the flattened head, if caused by sleeping position, is usually simple and painless for your child. Your child's doctor will probably recommend alternating both your child's direction in the crib (one night with his head toward the top of the crib, one night toward the bottom) and his head position during sleep (one night with the left side of his head touching the mattress, one night with the right).

Even though your child will probably move his head around throughout the night, alternating sides is still beneficial. There are wedge pillows made to keep babies lying on one side or the other, but be sure to check with your doctor before using one to ensure that it is appropriate and safe for your baby. The AAP does not recommend using any devices that may restrict the movement of an infant's head.

In addition to alternating sides, you may want to consider moving your baby's crib to a different area of the room. If there's something in the room (a window or toy, for example) that is catching his attention and causing him to hold his head in a similar position day after day, moving his crib will force him to look at it from another position.

Always be sure your baby gets plenty of time on his stomach during the day, especially while he is awake and you are nearby. Not only does "tummy time" give the back of your baby's head a rest, it also helps in other ways. Looking around from a new perspective encourages your baby's learning and discovery of the world. Plus, being on his stomach will help him learn to push up on his arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen his neck muscles.

If torticollis is the cause of your baby's flattened head, a course of physical therapy and a home exercise program will usually do the trick. A physical therapist can teach you exercises to do with your child at home.  Most moves will consist of stretching your child's neck to the side opposite of the tilt. Eventually, the neck muscles will be elongated and the neck will straighten itself out. Rarely, surgery is needed to correct the problem.

For kids with severe positional plagiocephaly, doctors may prescribe a custom molding helmet or head band. These work best if started between the ages of 4 and 6 months, when your child grows the fastest, and are usually less helpful after 10 months of age. They work by applying gentle but constant pressure on a baby's growing skull in an effort to redirect the growth. You should never purchase or use any devices like helmets or bands without having your child first evaluated by a doctor.

Although helmets may not improve the outcome in all children, some children with severe torticollis would be more likely to benefit from their use."

Questions and referrals can be directed to (717) 531-0857..

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