When a baby develops a flat spot, either in the back or on one side of the head, it could be a sign of a positional head deformity. Also referred to as positional plagiocephaly or flattened head syndrome, this can occur when a baby sleeps in the same position repeatedly or because of problems with the neck muscles (torticollis). Because infants' heads are soft to allow for the incredible brain growth that occurs in the first year of life, they're susceptible to being "molded" into a flat shape. Fortunately, positional plagiocephaly usually is easy to treat, and with appropriate intervention will correct itself by the time a child is 1 year old. Premature babies are more vulnerable to positional head deformities because their skulls are softer than those of full-term babies and because their medical needs sometimes result in spending a great deal of time on their backs without being moved or picked up. Positional head deformities shouldn't be confused with craniosynostosis, a more serious condition that occurs when skull bones fuse together too soon, causing an abnormal skull shape and possible brain damage if the condition is not corrected. Craniosynostosis is usually corrected with surgery.
Diagnosing positional head deformity
A child’s physician usually makes a diagnosis of positional plagiocephaly simply by examining the child's head. The doctor will also note whether regular repositioning of your child's head during sleep successfully reshapes the growing skull over time. X-rays or a CT scan of may be necessary to confirm diagnosis or clarify if the skull bones are normally separated or if they fused together too soon. If the bones aren't fused, the doctor will rule out craniosynostosis and confirm that the child has positional head deformity.
Treatment of positional head deformity
Treatment for positional plagiocephaly caused by sleeping position is usually easy and painless, entailing simple repositioning of babies during sleep to encourage them to alternate their head position while sleeping on their backs. Always be sure your baby gets plenty of supervised time on the stomach while awake during the day. Not only does "tummy time" promote normal shaping of the back the head and helps babies learn to push up on their arms, which helps develop the neck muscles. If torticollis is the cause of your baby's flattened head, your physician will order a course of physical to teach you exercises to do with your baby involving stretching techniques that are gradual and progressive to elongate the neck muscles, which will allow them to support the child’s head better in a way that allows the head deformity to correct itself. For children with severe positional head deformity, doctors may prescribe a custom-molded helmet or head band. These work best if started between the ages of 4 and 6 months, when a 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.
Long term outlook for children with positional head deformity
The outlook for babies with positional head deformity is excellent. Most deformities are self-corrected by the time the child is 1 year old. A persistent deformity can be corrected with reconstructive surgery between 12 and 18 months of age, but very few cases require this.
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