Plagiocephaly

Plagiocephaly, also known as flat head syndrome,^[1][2] is a condition characterized by an asymmetrical distortion (flattening of one side) of the skull. It is characterized by a flat spot on the back or one side of the head caused by remaining in a supine position for too long.^[3]

Physiologically and other kind of cranial deformities

Etymology: Greek plagios "oblique, slanting," from PIE plag- "flat, spread," from *plak,^[4] and cephal Modern Latin "head, skull, brain,"^[5] together means flat head. Plagiocephaly is the word that is used to describe a diagonal asymmetry across the head shape. This word particularly describes a flattening which is to one side at the back of the head and there is often some facial asymmetry. Plagiocephaly divides into two groups: synostotic plagiocephaly, with one or more fused cranial sutures, and nonsynostotic (deformational) plagiocephaly. Surgical treatment of these groups includes the deference method; however, the treatment of deformational plagiocephaly is controversial.^[6] 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.^[7] Treatments range from a simple repositioning of babies below the age of 5 months to more involved treatment with a helmet for children under the age of 18 months.^[3]

Prognosis

Preliminary research indicates that some babies with plagiocephaly may comprise a high-risk group for developmental difficulties.^[8][9][10]

Prevention

Following tools and therapy could serve as an effective and safe treatment modality on managing this development disorder such as:

1. Tummy time.
2. Carrying the infant
3. Specialist baby mattress^[11][12]
4. Specially Designed weight distribution baby pillow.^[13][14]
5. Specially designed infant headwear with a support roll which ensures the head is positioned correctly and can be adjusted every few hours. This eliminates any potential flat spots and prevents them in the critical early growth stages of the child's life.^[15]

Treatment

The condition will usually improve to some extent as the baby grows, but in many cases, treatment can significantly improve the shape of a baby’s head. Initially, treatment usually takes the form of reducing the pressure on the affected area through repositioning of the baby onto his or her abdomen for extended periods of time throughout the day.

Other treatments include repositioning the child's head throughout the day so that the rounded side of the head is placed dependent against the mattress, repositioning cribs and other areas that infants spend time in so that they will have to look in a different direction to see their parents, or others in the room, repositioning mobiles and other toys for similar reasons, and avoiding extended time sleeping in car-seats (when not in a vehicle), bouncy seats, or other supine seating which is thought to exacerbate the problem. If the child appears to have discomfort or cries when they are repositioned, they may have a problem with the neck.^[16]

If this is unsuccessful, treatment using a cranial remolding orthosis (baby helmet) can help to correct abnormal head shapes. These helmets are used to treat deformational plagiocephaly, brachycephaly, scaphocephaly and other head shape deformities in infants 3–18 months of age by gently allowing the head shape to grow back into a normal shape. This type of treatment, although in some countries controversial, have a long and successful history in radically improving the head shape.^[17]

Studies by researchers in the Netherlands reported that there was no significant difference over time between infants treated with helmets and infants left untreated. This randomised study followed 42 infants in a treated and 42 in a non treated group. Of the infants in the treated group, only 30 were fitted with orthoses. 22 of the 30 reported problems with the fit of the helmet. The parents of infants treated with helmets confirmed negative side effects including skin irritation, sweating, unpleasant odor from helmet, and feeling hindered from cuddling their child.^[18][19] This study focused on patients with moderate to severe cases, the participation rate was only 21% (84 of a total 403 eligible infants), and there was a 73% reporting of fitting issues,^[20] calling into question the problems in the study. Incorrectly fit devices cannot be expected to yield results. Additionally, independent published research that examined the effectiveness of helmet therapy conclude that as many as 95% of patients demonstrate an improvement in head shape symmetry following helmet therapy, and the American Orthotics and Prosthetics Association (AOPA) has serious concerns about the relevance and validity of this study.^[21] This study is at odds with the results proved in all other studies and reduces its data to two lines of aggregated results.

A recent study at Alder Hey Children's Hospital aimed to document changes in head shape associated with use of a passive orthotic mattress for the management of positional plagiocephaly. The study of 30 patients with plagiocephaly at Alder Hey Children's Hospital took place between April 2008 and June 2010. Cranial vault asymmetry was assessed before treatment and was classified into mild, moderate, or severe plagiocephaly. Follow-up after 6 months of using the mattress demonstrated a significant improvement in cranial vault asymmetry in those treated with the passive orthotic mattress.^[22] Whilst this type of mattress is useful in helping to prevent a deformity, there is less evidence to show that it will improve an existing deformity.

References