Lying or Sleep Position Affects Baby's Head Shape; Prevention and Advice
Your baby's head may appear too large for its body. The head makes up one-quarter of your baby's total body size. It is an average of 13 - 14 inches around at birth. Your newborn baby will probably spend a lot of time sleeping or eating. All babies are alike in some ways, such as needing sleep, feedings, and love. In most other ways, your baby is not like any other baby.
But if you've noticed that your baby is developing a persistent flat spot, either in the back or on one side of the head, it could be a sign of Positional Plagiocephaly. Also known as flattened head syndrome, this condition can occur when your baby sleeps in the same position repeatedly. It can also occur because of problems with your baby's neck muscles. Some babies may have the additional problem of torticollis, a neck muscle problem, which prohibits them from properly turning their head to another position.
Flat areas on the head, called "positional plagiocephaly" can develop very quickly (often within the first 2 months).Deformational plagiocephaly, also known as positional plagiocephaly. Infant sleep position impacts the development of head shape. Changes in infant sleep position, specifically the movement toward supine sleep, have led to a redefinition of normal head shape for infants in the United States.
Parents need to be aware of their infant's head position preference and remember to alternate head positions when putting the infant to sleep. This is even more important when cranial flattening is noted immediately following the birth of an infant. Some studies have suggested that the altered physical appearance reduces perceived attractiveness, which may affect bonding between the infant and parent. Untreated plagiocephaly may have some risk for long-term developmental consequences.
Anxieties about plagiocephaly, aspiration of vomit, and poor quality sleep are the main concerns that parents have about sleeping their infants on their backs. Plagiocephaly does not affect the development of the brain but, if it is not treated, may alter a baby's physical appearance by causing an uneven growth of the face and head, and can contribute to visual and sometimes hearing problems.
The ears and skull shape are symmetrical. With continued pressure from lying on the back of the head (arrow), the infant skull becomes progressively deformed. Most normal infants, when placed on their backs, spend most of their time (80%) with their heads turned toward the right, 10% of their time turned to the left, and only 10% of the time with their heads turned straight ahead. It is no surprise, then, that a recent study found that 80% of infants with OP had right occipital flattening, and the side that the child prefers to look almost always corresponds to the side of the flattening.
Skull flexibility is a biological advantage meant to help babies survive and develop. But because your baby's skull is malleable, too much time in one position can result in an uneven head shape well past the time when birth related lopsidedness evens out. This is known as positional molding. Positional molding is often most noticeable when you're looking at your baby's head from the top down.
Deformational Plagiocephaly (DP) is a multi-planar deformity of the cranium occurring either pre-or postnatal in infants. This can cause the baby to have a crooked looking forehead and face. These changes can remain for the rest of the child's life. You can help prevent this flattening by constantly changing your baby's head position. With appropriate intervention in most children, positional plagiocephaly will correct itself by the time the child is 1 year old. If so, to evaluate your infant's head shape, view the head from various angles: from the top, sides, the back and face on. Gently placing your fingers in the child's ears will help you see an ear shift.
It is well known that babies’ skull bones are very soft until about one year of age. Some babies show a preference for sleeping or sitting with their head turned in the same position for the majority of time. A flat area may develop very quickly or over several months and is often a result of the infant consistently lying on his or her back. Visually, your child may have one ear that is shifted forward of the other and may also have facial changes, e.g. forehead protrusion or cheek protrusion in more severe cases, on the flat side of the head.
Nighttime positioning combined with the additional time infants spend supine during the day in infant carriers, car seats, strollers, and supine play positions, places today's infants at a greater risk for the development of positional plagiocephaly. In a study of more than 7600 infants under 6-months-old in the Netherlands who were seen for scheduled postnatal visits, 8.2% of the children presented with either asymmetric flattening of the occiput or the forehead. In a follow up study, 50% of these infants continued to demonstrate reduced neck range of motion and flattening of the skull at 2 and 3 years of age.
A study shown that infants with deformational plagiocephaly comprise a high-risk group for developmental difficulties presenting as subtle problems of cerebral dysfunction during the school-age years. It has also been noticed in recent years that extended use of car seats, infant swings, and bouncy seats also contribute to Plagiocephaly. In these devices, the back of the head is often against an unyielding surface. While normal use is not a concern, extended use, especially allowing infants to sleep in them, increases Plagiocephaly.
The risk of positional plagiocephaly can be reduced by simply alternating the sleeping position of the infant, adding supervised tummy time during play, and being aware of which direction the infant tends to look. Early identification of a preferred head orientation, which may indicate the presence of neck muscle dysfunction, may help prevent the development or further development of nonsynostotic plagiocephaly in infants.
Preventive measure by positional therapy:
A 2-year study of the natural course of positional plagiocephaly found that the severity increased and peaked at 4 months of life and then improved over time. Most cases resolved clinically by 2 years of age. Limited head rotation, lower activity levels, and supine sleep position were important deterrents to improvement
Place the infant with his or head turned on the opposite side of the head. This can be achieved by placing a towel roll or rolled up blanket beneath the back on the flattened side, and by placing interesting objects on the opposite side of the bed to attract the infant’s attention. Change infant’s head position from side to side during feeding time.
The American Academy of Pediatrics (AAP) now recommends frequent rotation of a child's head as well as tummy time. Alternate the hip or arm with which you carry and feed your baby. Rotate the position of toys in the crib, stroller and car seat. Should repositioning alone be ineffective, a helmet or headband program may be implemented.
The American Academy of Pediatrics (AAP) recommends infants sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). Since then, medical providers have noted a significant increase in the number of infants presenting with deformational or positional plagiocephaly. These deformations are positional in nature, because of the extended time an infant spends lying supine (on his/her back) in a crib, car seat, or infant swing.” Back to Sleep" positioning recommendations aimed at decreasing the risk of sudden infant death syndrome.
Clinical evaluations indicate that the assistive device (AD) provided the most benefit when applied to 2- to 8-month-old children. Their result suggested that the AD may join molding helmets and physical therapy as a treatment for moderate to severe positional plagiocephaly in infants under the age of 1 year.
Supine positioning for sleep is clearly evidence-based and has saved the lives of many children. Results showed that infants who slept supine or in a side-lying position were less likely to roll over at the 4-month checkup than those who slept in the prone position. Another study suggested that prone positioning for play, even in small amounts, may relate to faster achievement of developmental milestones.
The rate of crib death or sudden infant death syndrome dropped markedly in the United States after pediatricians launched a "back to sleep" campaign. Researchers determined that many SIDS victims were smothered by their own bedding.
Make sure that your baby(ies) is placed off of the flat area at all times. This can be accomplished by placing a small, rolled up blanket under your baby's shoulder, on the same side as the flat area. This will help keep the baby's head turned away from the flat side. Make sure that the baby's underside arm is out so that there is extra protection against the baby accidentally rolling on its tummy.
Start by placing your baby on their tummy several times a day for a few minutes when they are awake. Plagiocephaly might also be prevented by varying the head position when putting the very young infant down to sleep and by giving supervised tummy time when awake. “Tummy time" is a time for playing with your baby. Do not allow your baby to fall asleep while lying on the stomach.
Place toys on different sides of your baby or talk to them from different sides. Vary the position you hold and carry the baby in e.g. using a sling, holding upright, carry over your arm on their tummy or side. Roll up a small towel and place it under your baby's chest, placing her arms in front of the towel. This will make it easier for her to hold her head up.
Put the baby to sleep at alternate ends of the cot or change the position of the cot in the room as babies tend to turn their head to look toward the centre of the room or doorway. Changing their cot position will encourage them to look at different angles.
Your baby's favorite place is in your arms. Holding your baby or wearing your baby in a front pack is a great way to get him off his head and move the head in different positions. This also allows your baby to experience a variety of positions and is great for bonding and play. Use a sling, hold upright for cuddles, and carry your baby over your arm on their tummy or side.
Scientific evidence to support the age-old belief that swaddled infants sleep better than unsaddled infants. It helps babies stay asleep and so may help parents keep their babies sleeping in the safer back position.
Watch to see if your baby likes to put his head to the same side all the time while sitting in a seat. Roll up a blanket or use a neck roll to put around the baby's head to keep the head in the center.
Device to correct:
With early detection and intervention, most positional head deformities can be treated conservatively with physical therapy or a head orthosis ("helmet").Study confirmed that improvement was significantly better and faster in the helmet group compared with non helmet treatment. The helmet essentially provides a tight, round space for the head to grow into. The helmet must be worn for 23 hours a day and may come off for one hour (ie to wash your baby’s hair).The helmet shape must be adjusted by the orthotist every 1-2 weeks and treatment usually takes between 2-6 months. Wearing the helmet doesn’t hurt and babies usually get used to it very quickly.
The T-Sleep device also appears to be safe and effective. The utility of a 3-D scanning device (noninvasive laser shape digitizer) also safe and the effectiveness of treatment with a cranial remolding orthosis.
Results suggest that the AD may join molding helmets and physical therapy as a treatment for moderate-to-severe positional plagiocephaly in infants under the age of 1 year.
Others have proposed molding helmets or head bands; specially constructed and individually tailored plastic helmets which gently mold the infant's skull back into place.
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