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Torticollis & Plagiocephally - flat head syndrome

Posted by Karen Faulkner on
torticollis, plagiocephally
I've been seeing a lot of flat heads in little babies recently and felt a blogpost was long overdue!

You're probably wondering what are these flat heads and how can I fix it?

I'm going to introduce 2 new medical terms to you: Plagiocephally and Torticollis.

Plagiocephally means misshapen or flat head. Torticollis is a shortened neck muscle. We know that a shortened neck muscle usually occurs in utero (in the womb) and is often a result of a malposition i.e. a position other than the normal occipital anterior position.

The torticollis needs exercising once baby is born and if this does not occur or if the lack of normal head rotation is not detected then a plagiocephally (flat head) can result.

When we do tummy time with our babies it is important to make sure the baby turns their head to both the left and right hand sides. It is important not to force the baby to turn his head. If you notice any resistance of rotation ask your nurse or doctor to check babys' head for a shortened neck muscle/Torticollis

"Plagiocephaly is the most common craniofacial problem today. Deformational plagiocephaly, also known as positional plagiocephaly, means a mis-shapen or uneven (asymmetrical) head shape. Plagiocephaly does not affect the development of a baby's brain, but if not treated it may change their physical appearance by causing uneven growth of their face and head. 

Here's a great blog about a baby and his journey to achieving a normal shaped head. Go Ben!

I want to look at prevention first as the flat head can be prevented if its picked up early enough.

Skull bones of a new baby are very soft so we need to start tummy time early, i.e. 2 weeks old.

floor play

The flat head syndrome is a relatively new thing and was not known pre SIDS back to sleep campaign. We've reduced the risk of SIDS but we've got misshapen heads as a result.

1) Tummy time 6 times a day, little and often is key. Start off with a few minutes 6 x a day and build up to 10-15 minutes by 3 months. Once they start to whinge pick them up. Get on the floor with them. If they prefer one side then get on the floor and look at the the side they are not turning to. Put toys on the least preferred side too.


2) Alternate the way they lay in the cot, move ends. Babies tend to look towards windows/lights. Move head to left and right positions during sleep.

3) Put a drawn face inside the cot, on left or right side at babes face level, drawn on paper and stuck down with something safe to the basinet - babies are always drawn towards faces. Use white paper and black marker pen. Place the drawn face on the side baby is not turning towards.

4) Alternate the arms you hold/carry/feed baby in to change head position.

5) Place a face-washer (or tea towel) in cot folded into 4 and placed under the shoulder to help the neck rotate easier. Only do this during the day when you are keeping an eye on baby. It is important to observe the SIDS recommendations at all times.

So for example my doll Albert has a right torticollis (short neck muscle) and is reluctant to turn his head to the left. I've placed the folded up tea towel under his right shoulder to rotate his body and encourage him to look to the left more.

I'm going to look at treatment next

The most common forms of treatment are counter positioning and/or helmet therapy:

1) Counter positioning
This involves parents making sure their baby does not rest on the flat spot by alternating their baby's head position from the back to the sides. Increased tummy time and lying your baby on their side to play can also help. Counter positioning techniques can be taught by health professionals, including maternal and child health nurses and paediatric physiotherapists.

Once baby is 4-8 months old and you notice an obvious flat or misshapen head it is important to consult a paediatric physic and/or a orthotist and/or plastic surgeon. These teams are commonly in large children's hospitals.

2) Helmet treatment

Sometimes when the uneven head shape is more severe or where counter positioning did not work, a cranial remodelling helmet can help. Helmets are lightweight and made of a thin hard shell with a foam lining for comfort. The helmet helps the skull re-shaping process by removing the pressure over the flat area, allowing the skull to grow into the space provided. Helmets work best between four and eight months of age.

A specialist, called an orthotist, makes a casting of your baby's head and custom makes the helmet. You do not need to shave your child's hair.

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 one to two weeks and treatment usually takes between two to six months.

Wearing the helmet doesn't hurt and babies usually get used to it very quickly. Parents can feel quite emotional when their child first wears the helmet. It can be helpful to know this is a common feeling and to remember treatment is temporary and outcomes are normally very good.

It is important to remember that most positional plagiocephally can be corrected by tummy time. Helmets are a last resort but are a very effective treatment. 

If you have any concerns about tummy time or if you're not sure about the shape of your baby's head please talk to your child and family health nurse or paediatrician or GP.

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