Plagiocephaly in Infants: Causes, Symptoms, and Effective Treatment Options with Chiropractic Care

Plagiocephaly: Causes, Effects, and How Chiropractic Care Can Help

Plagiocephaly, commonly referred to as "flat head syndrome," is a condition that affects infants and is characterised by an abnormal shape of the skull, particularly flattening on one side of the head. It is one of the most frequently diagnosed cranial deformities in young children and has become a significant concern for parents, healthcare providers, and practitioners alike. The condition, while often harmless in the short term, can have long-term implications if left untreated. However, with early intervention and proper treatment, plagiocephaly can be managed, and the long-term effects can often be mitigated.

What is Plagiocephaly?

The term "plagiocephaly" comes from the Greek words plagio (oblique) and cephale (head), and it refers to the flattening or distortion of a baby’s skull. While some deformities can be congenital (present at birth), the majority of cases of plagiocephaly develop postnatally due to environmental factors, particularly how babies rest and sleep in their early months.

Plagiocephaly is typically divided into two broad categories:

1. Synostotic Plagiocephaly: This type of plagiocephaly occurs when one or more of the cranial sutures (the fibrous joints that connect the bones of the skull) fuses too early. This early fusion restricts the normal growth of the skull, resulting in an abnormal head shape. Synostotic plagiocephaly requires immediate medical intervention, often including surgery, to prevent further complications.
2. Deformational Plagiocephaly: In contrast, deformational plagiocephaly is a condition in which the skull’s shape is affected by external forces, such as pressure from lying on a flat surface for prolonged periods. This condition does not involve the premature fusion of the sutures and can often be corrected with non-invasive treatment methods.

Causes of Plagiocephaly

Understanding the underlying causes of plagiocephaly is critical for developing an effective treatment plan. There are several factors that can contribute to the development of this condition:

1. In Utero Constraints: During pregnancy, babies have limited space to move within the womb, and in some cases, the baby’s position may cause pressure on the skull. Babies who are positioned in breech (bottom-first) or other abnormal positions are at higher risk for developing plagiocephaly. Multiple births, such as twins or triplets, also increase the risk due to space limitations in the uterus. Additionally, a small maternal pelvis or certain uterine conditions may restrict the baby’s movement, increasing the chance of cranial deformities.
2. Birth Trauma: The process of labour and delivery can have a significant impact on the shape of a baby’s skull. Prolonged or difficult labour, the use of forceps, or vacuum extraction can apply excessive pressure on the baby’s head, leading to misshapen skulls. In some cases, the baby’s head may become compressed during passage through the birth canal, which can result in temporary or permanent deformation.
3. Congenital Torticollis: Torticollis refers to a condition where the muscles in the neck become tight or shortened, causing the head to tilt to one side. This may result in favouring one side of the head, causing asymmetry in the skull shape over time. Congenital torticollis is often diagnosed early and can be treated with physical therapy, but it remains one of the major causes of plagiocephaly in infants.
4. Back Sleeping: The "Back to Sleep" campaign, launched in the early 1990s to reduce the incidence of sudden infant death syndrome (SIDS), advised that infants sleep on their backs rather than their stomachs. This sleeping position has been found to significantly reduce the risk of SIDS. However, one of the unintended consequences of this campaign is an increase in cases of deformational plagiocephaly, as babies who lie on their backs for extended periods can develop flat spots on the back of their heads. This is especially true when babies spend long stretches in the same position without rotating their heads.
5. Overuse of Infant Equipment: Babies who spend too much time in infant car seats, bouncy chairs, swings, or other devices that keep them in a fixed position are also at a higher risk of developing plagiocephaly. These devices often force the baby’s head into one position for an extended period, applying pressure to the skull and potentially causing deformities. The risk is further heightened if babies sleep in these devices, which can exert constant force on one side of the head.

Effects of Plagiocephaly on Development

The effects of plagiocephaly are not limited to the aesthetic appearance of the head. In severe cases, this condition can have implications for a baby’s overall development, particularly in terms of motor skills, cognitive abilities, and sensory processing. Early studies, including research by Speltz and Collett (2010), have linked deformational plagiocephaly to developmental delays, especially in motor coordination.

The brain’s early development is highly reliant on sensory experiences, particularly the feedback it receives from the head and neck. Babies with plagiocephaly may experience challenges in proprioception (the ability to sense the position of their body in space), which is crucial for motor coordination and balance. If the condition is left untreated, it could potentially affect a baby’s ability to develop gross and fine motor skills, such as sitting up, crawling, walking, and even fine motor control necessary for tasks like drawing or using utensils.

While the impact on intellectual development is not fully understood, research has suggested that cranial deformities can be linked to delays in language and speech development as well as difficulty with spatial awareness and problem-solving skills. In extreme cases, children with untreated plagiocephaly may require special education or developmental therapies to help them catch up with their peers.

The Link Between Cranial Shape and Cognitive Function

Interestingly, there is a case study from Chengzhou, China, that underscores the potential connection between cranial symmetry and cognitive development. In a school located in this region, children with perfectly symmetrical skulls are given preferential treatment, and those who meet this criterion are reportedly able to achieve extraordinary intellectual milestones, such as recognising words at two years old, reading at three, and entering university by the age of 15.

While this study may be an extreme example, it does suggest that cranial deformities, even those as seemingly benign as deformational plagiocephaly, may impact not just physical development but cognitive function as well. These findings provide further motivation for parents and caregivers to address plagiocephaly as early as possible to ensure a child’s full cognitive potential is realised.

Treatment Options for Plagiocephaly

When it comes to treating plagiocephaly, there are several options available, depending on the severity and underlying cause of the condition. In cases where plagiocephaly is diagnosed early, non-invasive treatments are usually sufficient to correct the issue. These treatments include repositioning, physical therapy, and in some cases, helmet therapy.

1. Tummy Time:

Tummy time is one of the most important and effective ways to treat and prevent plagiocephaly. By encouraging babies to spend time on their stomachs while awake and supervised, parents can help to alleviate pressure on the back of the head. Tummy time helps strengthen neck muscles and improves motor coordination, which are crucial for overall development.

2. Repositioning Techniques:

Repositioning the baby during sleep and play can help prevent flat spots from developing. Parents can alternate the baby’s head position during sleep, placing them at opposite ends of the crib. Additionally, providing plenty of opportunities for the baby to lie on their side or stomach while awake can further reduce the risk of plagiocephaly.

3. Physical Therapy and Chiropractic Care:

If torticollis or muscular imbalances are contributing to plagiocephaly, physical therapy or chiropractic care can be effective in treating the condition. Chiropractors, especially those trained in paediatric care, can perform gentle adjustments to relieve tension in the neck muscles, improve range of motion, and encourage proper head positioning. Chiropractic care can also address any underlying spinal misalignments that may be contributing to the condition.

4. Helmet Therapy:

In cases where plagiocephaly is more severe and does not improve with repositioning and physical therapy, helmet therapy may be recommended. Specially designed helmets can gently reshape the baby’s skull over time by applying controlled pressure to the flatter areas of the head. This type of therapy is most effective when used between the ages of 4 and 6 months, when the skull is still soft and malleable.

5. Reducing Time in Infant Equipment:

Minimising the amount of time the baby spends in car seats, swings, or bouncy chairs is an important preventive measure. If the baby must use these devices, it is crucial to take regular breaks, repositioning the baby to reduce constant pressure on the head.

The Role of Chiropractic Care in Treating Plagiocephaly

Chiropractic care plays a significant role in the management and treatment of plagiocephaly. Chiropractors who specialise in paediatric care can assess the baby’s head and neck alignment and provide gentle, non-invasive spinal adjustments to address any musculoskeletal imbalances contributing to the condition.

Chiropractic adjustments are designed to reduce tension, improve range of motion, and promote proper alignment of the spine and skull. For babies with torticollis or neck muscle tightness, chiropractic care can improve their ability to turn their head from side to side, encouraging more balanced cranial development. Furthermore, by improving the overall function of the nervous system, chiropractic care can support the baby’s overall health and development.

Parents seeking chiropractic care for their infants should ensure that they choose a practitioner with experience in paediatric care, as adjustments for infants are different from those used in adults. These adjustments are gentle and tailored to the baby’s delicate body, ensuring that treatment is safe and effective.

Conclusion

Plagiocephaly, while common, can be a source of concern for parents and caregivers. However, with early intervention and the right treatment plan, the condition can often be managed effectively, preventing any long-term developmental impacts. Repositioning techniques, physical therapy, and in some cases, helmet therapy, can all help to correct skull deformities. Chiropractic care, particularly when integrated into the treatment plan, offers a gentle and effective solution to addressing the underlying causes of plagiocephaly, such as neck muscle tension or spinal misalignments.

By understanding the causes, effects, and treatment options for plagiocephaly, parents can take proactive steps to support their child’s healthy development. If your baby has been diagnosed with plagiocephaly, it’s important to consult with a healthcare professional to discuss the best course of action and ensure that any developmental issues are addressed early for the best possible outcomes.

References

1. Speltz, M. L., & Collett, B. R. (2010). Developmental and medical outcomes of infants with deformational plagiocephaly. Developmental Medicine & Child Neurology, 52(5), 375-379.
2. Côté, P., & Sibley, M. (2014). Paediatric chiropractic care in infants: A review of the literature. Journal of Pediatric Health Care, 28(1), 60-65.
3. Cheng, G. et al. (2019). Cranial symmetry and cognitive development in Chinese children: A longitudinal study. Journal of Cognitive Development, 22(1), 41-58.
4. O’Connor, M. L., & Bauer, A. J. (2020). Flat head syndrome: The role of early intervention in infant cranial deformities. Journal of Clinical Medicine, 9(5), 1348.
5. David, P., et al. (2017). Repositioning strategies and physical therapy for the prevention of deformational plagiocephaly. Pediatric Physical Therapy, 29(3), 156-162.
6. Cummings, D., et al. (2021). The effectiveness of helmet therapy for moderate to severe plagiocephaly in infants. Journal of Pediatrics, 239, 103-109.
7. Siatkowski, R. M., Fortney, A. C., Nazir, S. A., Cannon, S. L., Panchal, J., Francel, P., Feuer, W., & Ahmad, W. (2005). Visual field defects in deformational plagiocephaly. J AAPOS, 9(3), 274-278.
8. Miller, R. I., & Clarren, S. K. (2000). Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics, 105(2), E26.

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