Wednesday, October 3, 2012

31 Days of Awareness: Plagio/Brachy Awareness

Plagiocephaly/Brachycephaly Awareness

Awareness Color: None
Awareness Week: In August (dates vary)

Plagiocephaly is the word that is used to describe a diagonal asymmetry across the head shape. This word particularly describes a flattening which is to one side at the back of the head and there is often some facial asymmetry. Brachycephaly describes a very wide head shape with a flattening across the whole back of the head.

Plagio and Brachy are becoming more and more commonplace since the Back-to-sleep campaign started to reduce SIDS. As a result, more and more infants are getting positional plagio due to constantly being on their backs. This is why tummy time is SO important.

Common Causes
Restrictive Intrauterine Environment
One of the leading risk factors in the development of plagiocephaly is a restrictive intrauterine environment. In this case, the infant does not have room to move, or becomes stuck in one position. The constraint may be caused by several sources: a very large or multiple number of fetuses (e.g., twins or triplets), a small pelvis, a small or malformed uterus, or if there is an excess or lack of amniotic fluid. A breech orientation can lead to an abnormal head shape when the infant's head becomes wedged under the mother's ribs. Mothers of children with plagiocephaly often report experiencing pain in the hip, from pressure of the fetus on the pelvic wall.
Congenital Muscular Torticollis (Wryneck)
In CMT, one or more of the neck muscles develops a tightness, causing the head to tilt and/or turn. This can result in plagiocephaly as the tightness causes the head to be held in a single position. Torticollis may be obvious or subtle.
Firmness of infant cranial bones increases nearly 5–10 fold during the last 10 weeks of pregnancy. Premature delivery makes the already soft cranium susceptible to molding forces. Premature infants are also more likely to be physically delayed, preventing normal movement of the head. Preemies will often spend extended time in the Neonatal Intensive Care Unit (NICU) on a respirator with the head in a fixed position. This can result in a long and narrow head shape.
Back Sleeping
Prior to 1992, the risk factors associated with plagiocephaly were considered to be a restrictive uterine environment and congenital muscular torticollis. After the American Academy of Pediatrics (AAP) made the 1992 recommendation to sleep infants only on their back to reduce the risk of SIDS, craniofacial centers began to see a dramatic increase in plagiocephaly. By 1996, several studies documented the relationship between back sleeping and plagiocephaly. The AAP now recommends frequent rotation of a child's head, as well as supervised tummy time.
Infant Car Seats, Carriers, Bouncy Seats and Swings
In recent years, it has been noticed that extended use of car seats, infant swings and bouncy seats also contribute to plagiocephaly. In these devices, the back of the head is against a rigid, unyielding surface, and the resulting deformity can be severe, even causing “cornering” or “squaring” of the head. While normal use is not a concern, extended use, especially allowing infants to sleep in them, increases the risk of plagiocephaly.


Since positional plagiocephaly is caused by there being too much pressure being put on one part of your infant's head, you can often prevent it from occuring by alternating the positions that your infant stays in. This does not mean that you should stop putting your child to sleep on their backs, put you can alternate your child's head position that he usually sleeps with.
Spending more time on his stomach (prone position) in 'tummy time' when he is awake and being supervised is also a good idea. And try to avoid letting your infant spend a lot of time in the same position on his back when he is awake. This may mean avoiding leaving your infant in car seats, when he is not in a car, and bouncy type seats for long periods of time. An infant sling or wrap can be a better alternative, as they put less pressure on your child's head, or use a stationary walker once your child is old enough to sit in one.
These preventative measures can be especially important for infants at higher risk of positional plagiocephaly, including preemies, multiples, and infants with poor muscle tone.
When should you start? Usually during the newborn period, when an infant's skull is 'maximally deformable.'


At first, the treatment of posterior plagiocephaly is the same as the preventative measures already discussed and include measures to keep your infant off the part of his head that is already flattened. Tummy time, alternating head position while sleeping on their back, and spending minimal time lying on their backs while awake can help most children with flat heads.
Improvement usually occurs over a 2-3 month period. If you do not see improvement or the deformity continues to worsen, then you child will likely need an evaluation by a pediatric craniofacial surgeon or a pediatric neurosurgeon. Although surgery is rarely needed, the specialist might recommend that a skull molding helmet or band be used.
Special attention should be made to infants with torticollis, as they often also need neck exercises as part of their treatment. These children often keep their heads in the same position and have trouble turning their heads and neck. Neck exercises, perhaps with the help of a Pediatric Physical Therapist, can help these children.

Where you can learn more:
Alvin with his cranial band.