Plagiocephaly, also known as flat head syndrome, is a condition characterized by an asymmetrical distortion (flattening of one side) of the skull. A mild and widespread form is characterized by a flat spot on the back or one side of the head caused by remaining in a supine position for prolonged periods.
Plagiocephaly is a diagonal asymmetry across the head shape. Often it is a flattening which is to one side at the back of the head and there is often some facial asymmetry. Depending on whether synostosis is involved, plagiocephaly divides into two groups: synostotic, with one or more fused cranial sutures, and non-synostotic (deformational). Surgical treatment of these groups includes the deference method; however, the treatment of deformational plagiocephaly is controversial. Brachycephaly describes a very wide head shape with a flattening across the whole back of the head.
Causes
Slight plagiocephaly is routinely diagnosed at birth and may be the result of a restrictive intrauterine environment giving a "diamond" shaped head when seen from above. If there is premature union of skull bones, this is more properly called craniosynostosis.
The incidence of plagiocephaly has increased dramatically since the advent of anti-sudden infant death syndrome recommendations for parents to keep their babies on their backs.
Data also suggest that the rates of plagiocephaly are higher for twins and multiple births, premature babies, babies who were positioned in the breech position or back-to-back, as well as for babies born after a prolonged labour.
Conditions and syndromes
Plagiocephaly is seen in multiple conditions: Arthrogryposis, cleft palate, craniosynostosis, and impaired intellectual development Autism, susceptibility to, X-linked 2 Blepharophimosis-impaired intellectual development syndrome Cardiac anomalies - developmental delay - facial dysmorphism syndrome CHIME syndrome Coffin-Siris syndrome 1 and 6 Congenital nonprogressive myopathy with Moebius and Robin sequences Cornelia de Lange syndrome 3 Cranioectodermal dysplasia 2 Craniosynostosis (nonsyndromic) 6 Developmental and epileptic encephalopathy, 1, 65, 77, and 84 Developmental delay with variable intellectual impairment and behavioral abnormalities Dihydropyrimidinase deficiency Early-onset progressive diffuse brain atrophy-microcephaly-muscle weakness-optic atrophy syndrome Faciocardiorenal syndrome FG syndrome Galloway-Mowat syndrome 4 Gaze palsy, familial horizontal, with progressive scoliosis 1 Hyperphosphatasia with intellectual disability syndrome 1 and 2 Hypotonia, infantile, with psychomotor retardation and characteristic facies 2 Intellectual developmental disorder, autosomal dominant 64 and 66 Intellectual disability, autosomal dominant 13, 40, 48, and 58 Joubert syndrome 1 Kleefstra syndrome 2 Langer-Giedion syndrome Microphthalmia with brain and digit anomalies Mitochondrial DNA depletion syndrome 13 Muenke syndrome Noonan syndrome 13 Osteogenesis imperfecta, type 20 Ritscher-Schinzel syndrome 4
Saethre-Chotzen syndrome
Spastic paraplegia, intellectual disability, nystagmus, and obesity
Syndromic X-linked intellectual disability Najm type
Diagnosis
A developmental and physical assessment performed by a physician or a pediatric specialist is recommended. Often imaging is obtained if the diagnosis is questionable to see if the baby's sutures are present or not. If the sutures are not present, craniosynostosis may be ruled into question.
It is also common for an infant with positional plagiocephaly to have misaligned ears (the ear on the affected side may be pulled forward and down and be larger or protrude more than the unaffected ear).
Prevention
Prevention methods include carrying the infant and giving the infant time to play on their stomach (tummy time), which may prevent the baby from progressing into moderate or severe plagiocephaly.
Letting babies crawl may also prove to be crucial in preventing plagiocephaly as it strengthens babies' spine and neck muscles. Crawling also boosts gross and fine motor skills (large and refined movements), balance, hand-eye-coordination and overall strength.
In addition, specialized mattresses are available to prevent plagiocephaly. The design of these mattresses is characterized by an ergonomic design that reduces pressure on the baby's head. It is very important that these mattresses are certified to guarantee their effectiveness.
Treatment
The condition may improve to some extent as the baby grows, but in some cases, home treatment or physical therapy treatment can improve the shape of a baby's head.