Positional Plagiocephaly: Causes and Treatments for Newborns
Positional plagiocephaly in newborns is one of the most common problems that babies develop in the first 2-4 months of life , a period in which the head is more malleable and grows quickly.
Because of the lack of advance knowledge about positional plagiocephaly, most parents are unaware of its existence until their child develops it.
In this article I will explain what positional plagiocephaly is, the causes of its occurrence and, above all, how to prevent or treat it effectively.
Before starting, I'll leave you some useful information:
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Positional plagiocephaly: general information
Plagiocephaly is a term that derives from the Greek and is composed of plagios, which means “oblique” and kephalè , which means “head”.
Plagiocephaly literally means oblique head , and owes its name to the fact that the newborn's head flattens at the back and gradually takes on the shape of a parallelepiped.
Positional plagiocephaly is often referred to as flat head , although this is not strictly correct.
Positional plagiocephaly, together with positional brachycephaly and positional dolichocephaly , is one of the 3 types of positional cranial deformations.
In the next paragraph I will explain what causes positional plagiocephaly in newborns, then we will understand how to resolve it.
Causes of Positional Plagiocephaly in Newborns
But why does the child always keep his head turned to the same side?
There are two causes :
1. the presence of myogenic torticollis in the newborn , i.e. muscle contractures and joint stiffness that limit the movement of the baby's neck and force him to always keep it rotated to the same side.
- 2. incorrect habits unconsciously put into practice by parents towards their newborn, who have accustomed him to always keep his head turned to the same side during the day and, consequently, also at night.
An example of incorrect positions are: - baby's position in arms
- baby's position for burping
- baby's position during breastfeeding or bottle feeding
- position of the child in the crib in relation to the parents' bed
- etc.
Positional plagiocephaly occurs in the first 3-6 months of life because this is the period in which the baby's head grows fastest but is also very malleable .
During this period, any incorrect positions held for too long can flatten and deform the baby's head.
However, after the first 4-6 months of life the baby's head grows less and less and becomes harder; consequently, plagiocephaly will take much longer to resolve (if caught early).
This is why it is important to prevent positional plagiocephaly or resolve it as soon as possible.
There are different degrees, but the worst leads to a deformation of the child's face . Therefore, it is of fundamental importance to act as soon as possible .
How to spot the onset of positional plagiocephaly?
As we said, plagiocephaly can have different stages .
In the early stages, you can spot it by looking at your baby's head from the back.
You may notice a slight flattening on one side of the posterolateral occipital region, which is the part of the head that rests against the bed.
If the child continues to keep his head rotated to the same side during the night and during daytime naps, the skull will continue to flatten and become deformed overall.
First the lateral part of the skull is deformed, and then the face (forehead, mouth, nose, eyes).
This is why in the more advanced stages the head takes on a rhomboid shape when viewed from above, as a global cranial deformation will manifest.
To detect positional plagiocephaly, the main characteristics to look for are the following:
- posterolateral flattening of the head in the occipital region;
- The profile of the head seen from above is not round and symmetrical;
- The sides of the head are not parallel to each other, but tend to be oblique;
- The positions of the ears are not symmetrical, but one will be more forward than the other;
- One eye may appear smaller than the other;
- Seen from the front, one side of the forehead appears higher than the other;
- the cheekbones and the profile of the mouth may appear asymmetrical between right and left.
These are the main signs to look for if you suspect positional plagiocephaly in your baby.
Classification of Plagiocephaly Degrees according to Argenta
The more time spent supine with the head turned to the same side, the worse the severity of positional plagiocephaly.
One of the best known methods for assessing the severity of positional plagiocephaly in newborns is the Argenta Classification , which is based on clinical observation of the head.
This classification proposes 5 types of plagiocephaly based on the severity of the asymmetry of the skull, the position of the ear and the appearance of the face (Argenta 2004).
Type I
Cranial asymmetry is limited to the posterior part of the skull.
The degree of posterior depression may vary, but the deforming action is limited to this anatomical region.
Furthermore, there is no asymmetry of the ears, assessed by measuring the distance from the nose to the ear.
Finally, the frontal scale is symmetrical, there are no abnormal temporal protrusions nor vertical elongation of the skull.
This represents the mildest form of positional plagiocephaly.
Type II
In this type of deformity, there are varying degrees of posterior cranial asymmetry. The effect on the midcranial line and the cranial base is quite significant, causing the ear on the involved side to be shifted forward or downward or both.
Asymmetry is usually most evident when examining the child from above.
However, the front of the skull is not involved and the forehead is symmetrical.
There is no facial asymmetry. There are no compressive deformities of the skull.
This type identifies a more severe form of positional plagiocephaly that affects not only the posterior skull, but also the cranial base and the central temporal fossa.
Type III
Type III deformity includes posterior cranial asymmetry, ear malposition, and prominence of the frontal bossing ipsilateral to the depression.
This shape gives rise to the parallelogram shape of the skull classically defined as characteristic of positional plagiocephaly and more easily detectable by examining the child directly from above.
However, in this degree of plagiocephaly the face is symmetrical.
Type IV
In type IV deformity, posterior cranial asymmetry, ipsilateral ear malposition, ipsilateral frontal and facial asymmetry are present.
Type V
In this grade, in addition to the asymmetries of the previous grade, a protrusion at the level of the temporal area and/or an anomalous vertical development of the skull at the occipito-parietal level is also evident.
Facial asymmetry is the result of displacement of the adipose tissue of the cheek or, less frequently, hyperplasia of the ipsilateral zygomatic area.
This degree of plagiocephaly reflects the progressive nature of the cranial asymmetry which ends up involving the anterior region causing facial deformation.