2023 Author: Anita Thornton | [email protected]. Last modified: 2023-05-22 03:30
“Too many babies with flat heads” according to the article on the subject of plagiocephaly published in the fall of 2017 in the newspaper La Presse. Recent studies on this clinical condition in infants are unanimous, to avoid wearing a helmet (cranial orthosis), screening for plagiocephaly must be done very early.
He alth professionals in Quebec interviewed in the article are also unanimous about flat head syndrome "there is not enough prevention, parents are poorly informed about plagiocephaly and torticollis which is often associated. Parents should be educated about this during prenatal classes and upon discharge from hospital at birth to prevent the problem from becoming entrenched.
At birth and during the first weeks of life, newborns spend more than 16 hours a day sleeping. The infant's skull during this period is particularly malleable. Flattening is caused by prolonged periods of sleeping on the back and in a sitting position during which the baby's head is rotated to one side only. This unilateral position of the head is often linked to torticollis from birth, which means that the child cannot place or keep his head on both sides, even with the intervention of parents.
Definitions of plagiocephaly
Flathead is more commonly used to define positional plagiocephaly in infants.
Plagiocephaly is defined by the following skull asymmetries (in varying degrees of severity); one half of the rear head is flatter with the forehead and the ear more advanced on the same side. The forehead on the opposite side to the bulging side appears flatter, and the eye on this side is smaller than the other. Overall the head looks like a parallelogram shape when viewed from above.
Another form of skull flattening is positional brachycephaly. It is defined by a flat in the center at the back of the head which causes a compensation in widening of the face. The lack of roundness of the back of the head in some cases gives in profile view a peak-shaped elevation of the skull.
In clinical practice, malformation or flattening of the skull in newborns is noticed by parents or diagnosed by physicians or other perinatal care providers around the age of 2 to 4 months. According to the article in the newspaper La Presse "the vast majority of parents notice that it was between the age of 4 to 8 weeks that they noticed that their baby's head had flattened… There is a prevention to doprecisely to prevent this”.
The causes of plagiocephaly and brachycephaly
The causes of flattening of the skull in newborns are related to several interrelated circumstances that can occur before, during and after birth. The position of the child's body and that of its head in the uterus during the last weeks of pregnancy can already cause a flattening or deformation of the overall volume of the baby's skull. A birth torticollis, which limits the rotation of the newborn's head, can contribute to flattening on one side only and cause the formation of plagiocephaly. However, the factor most often related to the formation of plagiocephaly and brachycephaly or the most aggravating is related to the sleeping position of the newborn.
Most clinical research links the dramatic increase in flathead cases over the past 20 years to the American Pediatric Society's "Sleep on Your Back" campaign (1992). The recommendations of this campaign are to make the newborn sleep on the back in order to reduce the risk of death caused by Sudden Infant Death Syndrome (SIDS). Recent clinical data estimate between 13% and 40% of the number of infants under one year of age who can be diagnosed with plagiocephaly or brachycephaly, according to a classification of degree of severity from mild, moderate to severe, in relation to the sleep recommendations on the back.
Contrary to previous medical beliefs and the trivialization of the flat head that it will correct itself over time, recent studies show that prevention from birth is essential in order to to avoid the flattening of the newborn's skull and aggravation. Expert recommendations are:
- From the moment the umbilical cord has fallen, it is important to put the baby on his stomach as often as possible during periods of wakefulness under the supervision of the parent. At first the infant does not like the position, however a few minutes (1 to 2 minutes before the age of 1 month and 3 to 5 minutes at the age of 2 to 3 months) on the belly several times a day will make the 'exercise to develop neck muscles more tolerable and enjoyable.
- Vary baby's positions regularly. In the bed for sleep and in the stroller alternate baby's position in order to stimulate the rotation of the head on both sides. Avoid leaving the child seated too long in the seats (deckchair and shell) when awake by favoring the baby carrier for the first 2 months of life.
- During waking periods on the back under the supervision of the parent place the baby between small rollers so that he is slightly on the side at 45 degrees (alternating sides) or use an ergonomic pillow under the head to prevent it from resting on a hard surface.
Treatment of plagiocephaly and brachycephaly
TheThe nature of treatments for correcting baby skull deformities has evolved over the past decade. From no treatment or intervention, it has evolved into approaches such as physiotherapy, wearing a cranial orthosis (helmet), positioning advice and osteopathy.
However, even if the importance of initiating treatment as early as possible has been established, we observe that parents and doctors delay interventions in the hope that the asymmetries will correct themselves, as as the baby grows. Progressive head reshaping, in many cases, does not occur and a delay in treatment can increase the severity of head flattening and increase the duration of helmet wear when it becomes unavoidable.
The helmet is custom molded to each infant's head to globally correct its shape. Depending on the age of the child and the degree of severity of the flattening of the skull the helmet can be worn for 3 to 5 months for 23 hours a day or less depending on the case at the end of the treatment.
Plagiocephaly, brachycephaly and osteopathy
The osteopathic treatment of plagiocephaly and brachycephaly, combined with positioning advice, offers an approach that can help correct skull malformations and avoid wearing a helmet, taking into account the age of the child and the severity of head flattening. The sutures of the skull are not yet “welded” before the closure of the fontanel (at the ageabout 12 months) and in this sense the osteopath applies precisely to make them more mobile, in order to allow a correction of the overall volume of the baby's head during the positioning periods.
Also, the work of the osteopath consists in identifying the muscular and ligamentous structures which present tensions caused by the birth torticollis linked to plagiocephaly. Using precise manipulations and without the use of significant force or tension, the osteopath restores the shape and mobility of these structures. Physiotherapy exercises should be taught to parents to help gradually eliminate birth torticollis.
To increase the potential for correcting the malformation of the skull and reduce the number of treatment sessions in osteopathy, as an osteopath specializing in pediatrics and cranial asymmetries, my clinical experience has led me to note that parental involvement is paramount.
I often remind parents that each of the positions in which the child is placed during sleep and wakefulness, counts in our work against flattening and is in favor of the rapid correction of the skull.
I use baby positioning recommendations with precise and easy-to-do instructions in everyday life at home and at all times. For certain malformations I teach parents techniques of "modelling" the baby's skull, this one done daily contributes toimprove the overall appearance of the skull, they are similar to the principle of modeling the helmet.
The number of osteopathic treatment sessions varies according to the age of the baby and the severity of the asymmetries. In osteopathic clinical practice, it is observed that it requires between 2 to 3 treatments for mild to moderate plagiocephaly or brachycephaly and between 4 to 5 treatments for more severe cases, taking into account of course all the factors of the overall condition of the baby.