Your baby almost always sleeps with his head turned to the same side. Taking him in your arms, you notice a small area behind his head where the hair seems less numerous or absent. By observing the shape of his skull, you note that it appears flat in the back. Your baby has possibly developed a positional plagiocephaly (also called cranial asymmetry or deformity). What are the causes? What can you do to prevent this deformity in your child? How chiropractic can help you?
Ever since many experts have recommended babies sleep on their backs during sleep to reduce the incidence of sudden infant death syndrome, there has been an increased incidence of positional plagiocephaly. [1] This type of asymmetry is caused by the effect of external forces on the skull. The shape of the skull is thus often described as a parallelogram. The main factors increasing the risk of positional plagiocephaly are:
- being male;
- being the eldest in the family;
- congenital torticollis (limited neck rotation at birth);
- exclusive bottle-feeding;
- wakefulness on the belly less than three times per day;
- sleeping on the back;
- sleeping with the head on the same side;
- limited activity level (caused by slower achievement of developmental milestones)1
Note the presence of this condition for 18% to 19.7% of healthy babies, and prevalence varies with age [2].
Preventing positional plagiocephaly
It is possible to prevent cranial asymmetry by applying these recommendations:
- Put your toddler on his stomach during waking periods at least three times a day for 10 to 15 minutes each time.1
- Alternate the direction of his head to the head or foot of the bed every day. He will want to see the room and the objects in it, and thus turn his head in that direction. It will be well positioned on a different side each night. [3]
- Limit time spent in car seats (transport shell), vibrating chairs and swings. Instead, use baby carriers to transport your child.3
- When he becomes more able to control the movements of his head, sit him in a BUMBO-type seat (or other equipment that provides support for babies that cannot maintain the sitting posture by themselves) to avoid that the back of his head be pressed against some random surface.3
Correcting positional plagiocephaly
To treat positional plagiocephaly, we must first limit the forces that exert pressure on the cranial bones, with the prevention methods mentioned above and correct mechanical faults, using manual therapies such as chiropractic, which prevent your baby from turning its head freely on both sides. It is important to act as soon as possible, in the first months of life, since the cranial bones are still mobile. In most cases, the asymmetry will be absorbed at two years old.1
Chiropractic care aims to restore adequate flexibility and regain full movement of the spine as well as other body articulations, muscles and ligaments. Your chiropractor is able to identify positional plagiocephaly and correct neck movement restrictions that predispose to this condition. For severe cases of deformity that have not responded to initial treatment, molding therapy (wearing helmet) may be indicated and should begin before the age of eight months.1
[1] Cummings. La plagiocéphalie positionnelle. Paediatr Child Health. 2011;16(8): 495-6.
[2] Pogliani L, Mameli C, Fabiano V, Zuccotti GV. Positionnal plagiocephaly: what the pediatrician needs to know. A review. Childs Nerv Syst, 2011, 27:1867-1876. Doi:10.1007/s00381-011-1493-y.
[3] Steward M, Mortenson P. A Clinician’s Guide to Positional Plagiocephaly: Everything you need to understand, prevent, identify and treat positional plagiocephaly. BC Children’s Hospital, June 2008;1-6.
