What is plagiocephaly? Can my child suffer it?

plagiocefalia
Photo: Spanish Association of Pediatrics

In 1992 the American Academy of Pediatrics the campaign started "Back to Sleep" in order to prevent sudden infant death syndrome. The recommendation to put babies to sleep on their backs has been very beneficial in reducing this terrible syndrome, but on the contrary we find that in health centers An exponential increase in cases of positional plagiocephaly has been detected.

The Spanish Association of Pediatrics defines positional plagiocephaly like a deformity of the back of the baby's head, that is produced during the first months of life and consisting of a flattening of the occipital region (from back) or parietal (from the sides), combined with a bulge on the opposite occipital side, an advancement and descent of the ear and a bulge on the forehead on the same side of the deformity.

Positional plagiocephaly it appears due to the pressure exerted by the weight of the skull itself supported by the same point (in the occiput) for a long time. This occurs mainly when babies maintain the same position on their backs both in the crib and on the lounger or when they get used to always sleeping on the same side, supporting the same head region for many hours.

The baby's head is made up of very malleable bone plates to allow the skull to grow. In the first months of life, they are very sensitive to external pressures and can easily deform if we do not take the appropriate positional measures.

According to the type of deformity, we classify it into: Plagiocephaly, Brachycephaly, Scaphocephaly

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Flattening it is produced when two factors coincide in time:

  1. During the first weeks is when the skull is at its peak of development (between the 38th week of pregnancy and the first 6 months of life) and therefore the bones are very cartilaginous and moldable to allow their growth.
  2. The baby's head control usually takes place between the second and fourth month. Until then, he has difficulty changing his position by himself, tending to support the same area of the head.

The most common causes of plagiocephaly are:

  • Prenatal causes: The fetus has been embedded in the pelvic canal for several weeks before delivery.
  • Perinatal causes: the deformation suffered during childbirth.
  • Postnatal causes: When the baby spends too many hours lying down in the same position.

In the first two cases, this deformity is considered normal, and in most babies the rounded shape recovers within a few weeks. Recent studies are beginning to point out that the shape of the skull is due more to postnatal factors than to the other two cases (link Pubmed). Specifically in week 2 to 4 is when the baby's head is most deformable (link here), for this reason pediatricians, nurses and physical therapists have long recommended a series of preventive measures to avoid the establishment of plagiocephaly.

It is vitally important to protect your head during the first months, following some simple tips that we summarize below:

  • Positioning:
    • For sleeping: the baby must rest lying on his back, ensuring that the head is tilted alternately to each side equally. That is, a third of the time supporting the right side, another third the left side and another third looking at the ceiling. These measurements are also recommended when they are in chairs and loungers until they have sufficient control of the neck muscles to allow them to change their position on their own.
    • "Tummy-Time": consists of putting the baby in the tummy position as long as possible, but only when he is awake and with the parents playing with him. The purpose of tummy time is threefold: strengthen the cervical muscles (essential to avoid or correct flattening) while playing, create a good bond with dads and leave a space of time in which the posterior bones of the skull do not receive any type of pressure.
    • Carrying in ergonomic backpacks appropriate to each age and motor moment of the baby, it has been shown to be effective both in preventing and treating plagiocephaly because, vertically, the posterior part of baby's head doesn't get as much pressure.
  • Stretching: Many times we find that the muscles on one side of the neck are more tense or shortened and means that when the baby sleeps he is more comfortable supporting most of the time the same side of the head. These stretches are very simple and you can do them at home, always following the advice of your doctor and physical therapist.

 

 

  • Specific cushion for plagiocephaly: Various theoretical studies have been carried out that show that the use of a cushion specifically designed for plagiocephaly is a very good option to avoid or treat it if it is already in place.
  • These measures are also collected in the form of a triptych in which the Hospital San Joan de Déu and the Catalan Institute of Health collaborate. If you want you can view it in this link.

Until recently, only positional measures existed to prevent plagiocephaly. In today's post we want to explain how the cushions designed to prevent and treat plagiocephaly are giving good results.

What is a positioning pad?

Cushions designed to prevent such deformation have a central cavity where the baby's head rests. This hole allows to increase the contact surface of the skull, so that the pressure decreases distributing the weight in a more uniform way throughout the posterior area. Thanks to this, we will ensure that when our child is lying down (in the crib, the chair or the lounger) the pressure exerted by the weight of the skull is distributed equally and not only in a small area, thus preventing it from being deformed. The central cavity of the cushion allows the baby to tilt his head easily and does not lose field of vision.

There are more and more cushions in order to combat positional plagiocephaly, although we are going to analyze the two that are endorsed, designed and / or certified by doctors:

 

Below we show you the comparison of these two cushions:

Cushion model for plagiocephaly

Babymoov's Lovenest

Mimes Cushion

Material

Cotton spandex State-of-the-art polyester materials that guarantee a product with a fully breathable and spongy three-dimensional structure that guarantees safety against accidental drowning and decreased head pressure. Only 6% of the total volume is made up of wire, the rest being air.

Measurements and sizes

One size.

Cushion measurements: 24x23x3cm

There are different sizes depending on the cranial perimeter, which ranges from 33cm to 50cm.

Pressures

(not specified) Reduces pressure up to 4 times less

Sites of use

Cot, cuckoo, deck chair, stroller and car seat Cot, cuckoo, deck chair, stroller and car seat

characteristics

Washable Anti-dust mite, washable and breathable.
Various colors to choose It serves both to prevent and to treat.
It is a preventive cushion It is symmetrical, you can put it on both sides, thus avoiding its deformation by use

Endorsed by doctors

Yes Yes

Certified to be in direct contact with baby's skin

Yes Yes

Anti-drowning certificate

(not specified) Yes

Age of use

From 0 to 4 months. One size. It has different sizes depending on the cranial perimeter.

Disadvantages

It has to be washed whole, it has no cover. It has to be washed whole, it has no cover.
It is only preventive Its price is higher

Advantage

There are different colors to choose It has the accidental anti-drowning certificate.
  Its shape and material allow it to deform less. Having sizes fits better to the baby's skull.

We like the use of a cushion because we see that it is a very simple and useful preventive measure to avoid or correct plagiocephaly. It allows us to make sure that the distribution of the weight of the skull is homogeneous when the baby is rested and we can be calm as it ensures that the baby's head is in good position without being so aware of the hours it spends supporting each side.

A cushion to avoid or treat plagiocephaly must be complementary to all preventive positioning measures. We recommend following the appropriate positioning guidelines since it is of utmost importance to vary the position of the baby from birth to prevent plagiocephaly and achieve good psychomotor development..

And above all, if you have any doubts or suspicions if your baby is starting plagiocephaly, go to your pediatrics for advice, advice and follow-up for your case.

             Laia Maseras Salvadó

Physiotherapist Col. 7098

Bibliography consulted

  • Morrison CS, Chariker M. Positional plagiocephaly: pathogenesis, diagnosis, and management. J Ky Med Assoc. 2006 Apr; 104 (4): pp136-140.
  • Wilbrand JF, Seidl M, Wilbrand M, Streckbein P, Böttger S, Pons-Kuehnemann J, et al. A prospective randomized trial on preventative methods for positional head deformity: physiotherapy versus a positioning J Pediatr. June 2013; 162 (6): 1216-1221.
  • Flannery AB, Looman WS, Kemper K. Evidence-based care of the child with deformational plagiocephaly, part II: management. J Pediatr Health Care. Sep-Oct 2012; 26 (5): 320-331
  • Persing J, James H, Swanson J, Kattwinkel J. Prevention and management of positional skull deformities in infants. Pediatrics. July 2003. Volume 112. Available at: http://pediatrics.aappublications.org/content/112/1/199.long

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