Plagiocephaly is a term used when describing a misshapen head.  Plagiocephaly is occurring with increased frequency since the introduction of the back to sleep program.  Because a newborn has minimal control of it’s neck muscles, when a child is born with a small flat spot on the side of their head and they are laid down on their back, they migrate to the flat area.  When a child’s head is maintained in a fixed positioned (against the uterus or a mattress) for 15-20 hours a day the head can and will change shape conforming to the flatness of the object.  So when we ask - why is my child’s head misshapen - the real answer is that your child’s head is doing what you have requested of it.   In Africa babies are strapped to a board so that their heads will be flat in the back and be higher posterior than anteriority.   This is considered a look of beauty and honor.   In essence this is what we as parents are doing to our children.  We are leaving them in a vulnerable position causing one side of the head to grow flat, one ear to shift forward and in some instances causing the eye on the non flat side to narrow. 

Studies have shown that children with plagiocephaly have lower developmental scores, on the Bayley Scales of Infant and Toddler Development, 3rd Edition (BSID- lll), in the areas of cognitive and language development. These studies show differences in childen up to 36 months of age. Plagiocephaly is no longer a cosmetic issue.

What can parents do about it?

Talk with your physician to see if an x-ray is warranted and start a repositioning program.   Repositioning means keeping the baby off the flat portion of their head 100% of the time.   Introduce a rice sock for positioning during sleep and increase tummy time.   A 3 month old infant should be able to spend 15 minutes on their belly comfortably. 

By using a rice sock under your child and changing the sock placement to the opposite side each night you can keep your baby in a 3/4 back/side lying position and make sure the pressure of the mattress is rotated from side to side of your child's head. 

If the head has a flat spot from birth - it is your job to keep the baby off the flat spot 100% of the time - This is accomplished by the positioning program outlined below. 

1. "Play in prone" or "Tummy Time"

  • by 3 months of age a baby should tolerate 15 minutes on their belly
  • infants should always be supervised when on their belly until they can roll over by themselves
  • tummy time can start with one minute and be increased by 15 seconds with each attempt

2. On the back

  • should be changed to a 3/4 side lying position with a rice sock or rolled up receiving blankets
  • this includes sleeping and play time

3. Car seat, stroller, bouncy seat, and swing

  • use 4 towel rolls: place one behind each of the infants shoulders to bring them forward and one along each side of the legs.   Both sides should have rolls to help keep the pelvis level so weight bearing is on both buttocks equally.   Use smaller rolls on each side of the head to keep it in midline.  the baby's neck and back should not arch.   The infant's back should rest in the back of the seat.  (see photo example below under torticollis)
4. Sitting

  • teach your baby to prop sit by 5 months and sitting independently by 6 months

CranioSacral Therapy and Plagiocephaly

We know that when the head is misshapen, the fascia covering the brain, pia mater, and the fascia attached to the skull, Dura mater, have abnormal or tight pulls in certain directions.   CranioSacral therapy can help by correcting the restrictions so the body can release the effects of stress naturally and relieve undue pressure on the brain and spinal cord.  By relieving the tight facial pull on the skull bones we are allowing them to realign.   This is a natural process to correct the shape of the baby’s head. 

What we know - after the birth process the head shape improves in the first 6 weeks of life.   Positionally we can change the shape of a baby’s head up to about 7 months.   85% of the postnatal skull growth occurs during the first year of life.   The research is out there, this is not a cosmetic issue.   Chiildren who suffer from plagiocephaly have lower scores on the Bailey cognitive (thinking) and motor exams. CranioSacral therapy is a natural way to correct the shape of your baby's head, releasing the tight cranial membranes and allowing the brain to process information the way it was intended. 

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Torticollis is a tight sternocleidomastoid (SCM) muscle.  This muscle starts at the mastoid process (behind the ear) and runs down the neck to the sternum and clavicle (breastbone).  When this muscle is tight, it makes a person look in the opposite direction and bring the ear closer to the shoulder on the same side.  Having a misshapen head can lead to a torticollis, and having torticollis can lead to a misshapen head.  In an infant, both are usually caused by the way the baby was positioned in utero. 

What can parents do about it?

Start with getting an evaluation by a pediatric physical therapist.  They should measure all cervical ROM and start you on a home exercise program (HEP) of proper positioning, stretching, then strengthening.

Suggestions for Torticollis Positioning

plagio car seat

Positioning in the car seat, stroller, and bouncy

  • Use towel rolls behind infant’s shoulders, along side of the trunk, and legs.  The shoulders should be forward of the towel rolls.
  • Both sides should have rolls to help keep the pelvis level so weight bearing is on both buttocks equally.
  • Use smaller rolls on each side of the head to keep it in midline.  Neck and back should not arch. Back should rest in back of seat.

Suggestions for Carrying your Infant with Torticollis

tort stretch

Examples for Left side torticollis

  • Carry infant on your right hip to encourage left head, neck, and trunk righting reactions.
  • When your infant is on your left shoulder, use your left cheek to prevent infant’s head from sidebending to the left side.
  • Hold infant facing away from you in a left side-lying position.   Infant's back is to your chest.   Gently place your right arm between your baby's legs and support your baby firmly around the bottom and chest/tummy with your forearm.  Your right hand can rest on the infants left shoulder.   Take your left hand to control the infants head in midline. If your arms are to short try the option below.

  • Cambria stretch

  • Hold infant in left sidelying with infant facing away from you.  Allow the infants left cheek to rest on your left arm by placing your forearm between the infants left ear and shoulder.  Gently place your right arm between your baby’s legs and support your baby firmly around the bottom and chest/tummy with your forearm.

Craniosacral Therapy and Torticollis

jugular foramina

We know that the cranial nerve (spinal accessory) that innervates the SCM exits the skull from the jugular foramina, a space, between the temporal and occipital bones.  If the head is misshapen, this hole may be decreased in size and the nerve can have trouble getting all its information through to the muscle.  We also know that if the head is misshapen, that the fascia covering the brain and the fascia attached to the skull (the intracranial membrane system) have abnormal or tight pulls in certain areas.  Craniosacral therapy can help by relieving the tight facial pull on the skull bones allowing the bones to realign if they want to and returning the hole to its natural size.

When the Intracranial Membrane System exits the skull it becomes known as the dural tube. The dural tube attaches to the peristoem of the coccyx. This creates a facial connection from the skull to the sacrum.   An infant with torticollis may have tightness in their sacrum creaing an imbalance in the pelvic region.  CST can be utilized to release any fascial restrictions in the pelvic region that may translate up to the skull enhancing a torticollis.

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