PLAGIOCEPHALY
Plagiocephaly, commonly known as flat head syndrome, is a condition characterized by an asymmetrical and flattened appearance of the head, where one side is more flattened than the other. The shape often resembles a parallelogram, with one side of the forehead pushed further out, and there can be noticeable shifting in the position of the jaw and ears. One eye may appear larger than the other.
While many parents initially assume that plagiocephaly is merely a cosmetic issue, there are more significant concerns associated with moderate to severe cases, particularly regarding the alignment of facial features and potential health issues. See key concerns of moderate to severe plagiocephaly below.
- Misalignment of the Upper and Lower Jaw (Cross Bite): The shifting of the jaw can lead to misalignment, which may cause issues with chewing and speaking.
- Temporomandibular Joint (TMJ) Problems: In adolescence, this misalignment can lead to TMJ disorders, characterized by clicking and/or pain while chewing and speaking.
- Visual Issues: Misalignment of the eyes can result in difficulties with fitting glasses properly and other vision-related issues.
- Facial Asymmetry: A shift in the underlying bone structure can cause one eye or cheek to appear larger than the other, which can have long-term implications beyond aesthetics.
PLAGIOCEPHALY TREATMENT
The treatment of plagiocephaly varies depending on the age of the infant and the severity of the condition. Options range from specialized therapies to home-based programs and, in some cases, the use of a cranial band. While cranial bands can be effective, they are generally considered a last resort after other treatments have been attempted. Treatment approaches include:
Home Program: An individualized program tailored to each infant’s specific head and neck needs. This includes:
- Positioning techniques to alleviate pressure on the flattened area.
- Activities and exercises designed to encourage symmetrical head shape development.
Specialized Therapy: For cases of moderate to severe plagiocephaly, brachycephaly, and/or torticollis (a condition where the neck muscles are tight or shortened), specialized therapy may be recommended. This typically involves:
- An average of 1 to 4 sessions, with torticollis cases potentially requiring several months of therapy.
- Techniques used may include:
- Neurodevelopmental Techniques
- Myofascial Release
- Craniosacral Therapy (CST)
- Kinesiotaping
Cranial Band (Orthotic Treatment):
- A cranial band is used in more severe cases when other methods have not provided sufficient improvement.
- The infant remains comfortable wearing the cranial band, but the aim is to minimize its use due to the time and cost involved.
Patient Comfort and Experience
- Most babies find therapy sessions engaging and interesting, with minimal crying or discomfort.
- Over years of treating infants, we have developed methods that are both effective and comfortable for both the baby and parents.
- To ensure a positive experience, we encourage scheduling appointments when the baby is well-rested, fed, and happy.
BRACHYCEPHALY
Brachycephaly, or flat head syndrome is a head shape condition where the head is wide in proportion to the length. It creates a flattened but symmetrical appearance in the back. Often the head appears vaulted or taller in the back.
A mildly wide head is not of concern and is representative of the differences between families and ethnicities and sleep position. However, when moderate to severe there are potential issues later in life related to jaw issues and the shape of internal structures such as the sinuses. Also, safety helmets for sports and occupations may not fit optimally (or at all). Cases of brachycephaly are increasing due to many factors and is much more complex than “it’s due to sleeping on back“. The babies that enter our doors typically have additional factors such as prematurity, reflux, low birth weight, torticollis, dislike or unfamiliarity with tummy time and sidelying when awake, multiple birth, and/or a less than optimal position inutero. Overuse of equipment such as swings and carseats, especially when not traveling, can also contribute to brachycephaly for some infants. See our article about one such piece of equipment, the Snoo, here.
Brachycephaly is closely related and treated similarly to plagiocephaly. Some infants have both brachycephaly and plagiocephaly.
TREATMENTS FOR BRACHYCEPHALY
Depending on age and severity there are different ways to correct brachycephaly. These range from:
- Specialized occupational or physical therapy
- An individualized program of positioning and activities at home
- A cranial band
While we are highly skilled and have excellent results with the cranial band we utilize, we are devoted to limiting to their use to only those infants for whom other means have been exhausted. The infant is comfortable in the cranial band. It’s the time and cost that we try to avoid.
- A home program individualized for the particulars of each infant’s head and neck. This includes positioning and activities and exercises.
- Specialized therapy for cases of moderate to severe brachycephaly and/or torticollis. Varies from an average of 1 to 4 sessions. Torticollis issues may need therapy for a period of months.
- Neurodevelopmental techniques
- Myofascial release
- Craniosacral Therapy (CST)
- Kiniesiotaping
- Cranial band or orthotic treatment
Most babies find therapy sessions engaging and interesting and there is little crying. We’ve treated so many infants for so many years and have developed methods which are effective and comfortable for the baby and parent.
TORTICOLLIS
Torticollis is a condition where an infant has a preference for looking in one direction. Often the baby also tilts her head and has other related asymmetries. Intervening when this is first noticed is highly recommended to avoid further complications.
- By addressing early, from a couple weeks of age on, the infant is set to develop symmetrically.
- The ability to roll left and right.
- The ability to use both hands equally.
- The baby’s head shape has a better chance of developing naturally
- Issues of plagiocephaly & brachycephaly will be lessened.
- Often, 1 to 3 therapy sessions and an individualized program for home is all that is needed.
TREATMENT OF TORTICOLLIS
Occupational or physical therapy is often recommended for infants with torticollis. The highly specialized therapists at Carolina Kinder Development:
- Start with a thorough evaluation of your infant.
- Come up with a plan to best help your baby.
We understand that part of the plan may be related to insurance benefits and encourage you to speak with us freely as to possible constraints so we can best help your baby.
- Specialized, individualized pediatric occupational or physical therapy with a focus on a Home Program
- Craniosacral Therapy (CST) is a gentle and effective manual therapy that by releasing restrictions, improvements in feeding, torticollis and development are often seen
- Cranial bands or orthotics (baby helmets) may be recommended if plagiocephaly or brachycephaly are noted. This recommendation is based on a combination of factors – severity and age being key factors.
To help parents of infants who want to learn about head shape and development, CKD created a series of infant development videos. They are full of ways to make your baby’s routines help head shape and development. They ideal for all babies and an excellent starting place for babies with torticollis.
OUR EXPERIENCE WITH CRANIAL BANDS
In 2018, of all the babies that came through our doors, 27% needed a cranial band. Our goal is to help your infant get the best and most thorough end result as cost effectively as possible. That means, our highly specialized therapists were able to help 73% of the babies we served through various forms of occupational and physical therapy.
Note: It becomes even more likely a cranial band will not be needed when we see a baby early (4-8 weeks of age).
We are highly experienced with cranial band treatment and also seek to understand the underlying reasons of head shape, not all infants need a cranial band. However, a cranial band is a valuable tool. We are experts in using it and have an excellent correction rate. But it is not the only tool in our toolbox.
- We ruthlessly hone our skills.
- We have developed preventative programs, both free and paid, so that parents have the information they need.
Please don’t feel bad or guilty if your baby needs a cranial band! Embrace it as the wonderful tool it is!
CRANIAL BANDS
Cranial band is a term that can be used interchangeably with cranial orthotic or baby helmet. Cranial banding:
- Reshapes the skull
- Improves an abnormal head shape
- Improves jaw alignment
In the case of the Ballert cranial band utilized here, it is a dynamic device (a device that applies a low energy load to constrain and correct abnormal growth) that has a single lateral opening on the side adjacent to the flattened occipital-parieto region and an opening on top for air flow. The Ballert cranial band is very light in weight some as little as 4.6 ounces.
CRANIAL BAND OPTIONS
At Carolina Kinder Development, our approach is very individualized and thorough based on the particular needs of your infant.
Some infants need therapy only.
Some need a cranial band only.
Some need both.
The table below will give you an idea of expectations. After assessing your infant, we will be able to answer all of your questions more specifically.
