Early diagnosis is key to treating positional plagiocephaly
John-Peter Temple, MD, Gundersen Pediatric Neurology
Since the early 1990s, the incidence of SIDS dropped by 40 percent after the American Academy of Pediatrics (AAP) recommended that babies be placed on their backs to sleep. While the AAP still recommends back-sleeping to prevent SIDS, they've since discovered a correlation between back-sleeping and positional plagiocephaly.
"In recent years, we've seen an increase in positional plagiocephaly. It is the result of sustained supine positioning in the crib, with the child having a preference for keeping the head turned to one side or the other. The problem can also originate before a baby is born due to restriction of movement in utero," states Gundersen Health System neurologist John-Peter Temple, MD. "About 95 percent of the time, positional plagiocephaly is the reason for abnormal skull shape. Less than 5 percent of the time it is due to premature closure of the suture lines."
While positional plagiocephaly does not cause pressure or damage to the brain, it can lead to a real cosmetic difference, including flattening of the back of the head, as well as asymmetry in the face and ears.
Infants typically respond very well to conservative treatment, such as repositioning and physical therapy, but treatment must start early.
Dr. Temple says primary care clinicians play a key role in identifying the problem. Here are two things to look for at initial well-child exams:
A digital handheld scanner allows Gundersen orthotist John Barteck to electronically capture the shape of an infant's head. The image is then used to manufacture a cranial remolding helmet and track treatment progress.
- Examine the overall appearance of the skull. Is there noticeable flattening on one side of the head? Is the skull shaped like a parallelogram?
- Assess for torticollis. Does the child have free range of motion, rotating chin to shoulder on both sides?
If there are concerns about either, consider a referral to Dr. Temple. He will take measurements to assess the severity and determine a treatment plan.
"It's important to get infants in early so we can make that referral to our developmental physical therapists and do the simple things first. If repositioning and stretching exercises are unsuccessful by four months of age, a cranial remolding helmet should be considered for severe cases," says Dr. Temple.
John Barteck, Gundersen Orthotics
Helmets work by re-directing the growth of the head, according to Gundersen lead orthotist John Barteck. "The helmet is fabricated to be more symmetrical than the infant's head—holding the areas that are more prominent and allowing the head to grow into the areas that are flat," he explains.
Gundersen orthotists use a handheld digital scanner to create the helmets. "In a minute or less, we can capture the exact shape of the infant's head—a much-preferred alternative to plaster molding because it allows for movement," states John.
While the helmets are manufactured in Florida, Gundersen orthotists perform all adjustments, fittings and follow-up care at their locations in La Crosse and Onalaska. "In addition to initial measurements, we use the scanner to take pictures throughout treatment, overlay the images and work in close collaboration with Dr. Temple to track progress."
Helmets are most effective when they are worn early and consistently. The ideal time to start helmet therapy is between four to six months of age. "Parental motivation is equally important, notes John, "As babies must wear the helmets 23 hours a day, seven days a week, and be seen for monthly follow-up appointments."
Early intervention is possible with your help. To refer a patient or for more information, contact Dr. Temple in Neurology via MedLink at (800) 336-5465 or in La Crosse at (608) 775-5465.
This overlay image shows the results of a child treated for positional plagiocephaly using a cranial helmet.