Flat Head Syndrome

When Rachel Manias' husband first noticed the facial disparities in their baby, they had never heard of positional plagiocephaly. Their son, Dane, had been taken to the neonatal intensive care unit (NICU) shortly after birth due to apnic attacks. He was later diagnosed with reflux, the cause of his attacks. While in the NICU, the Maniases were told to lay him on his right side because he would be more comfortable that way.

"My husband noticed the facial asymmetry at about six weeks," says Manias, an Ohio mother of two. "I thought he just looked that way from being squished at birth and it would be fine in a few more weeks. But when he was diagnosed with plagiocephaly, we went through his birth pictures and noticed that he didn't look that way when he was born."

What is Positional Plagiocephaly?

Positional plagiocephaly is a condition in which the back or one side of the back of an infant's head is flattened due to the infant spending a lot of time lying on his or her back. Normal growth of the skull in that area is restricted because of the persistent, chronic pressure of lying on that area. The skull bone of an infant is very malleable and easily deformed.

Rarely Serious, Easily Remedied

After their son was diagnosed, Manias and her husband began physical therapy for torticollis, a neck condition that also contributed to his plagiocephaly. They repositioned him while sleeping to keep him off that part of his head. "He did improve, but we weren't satisfied because of the facial and ear asymmetry," says Manias. "We decided to get a DOC (dynamic orthotic cranioplasty) band. We knew the best results are achieved when children are banded in the early months."

Plagiocephaly is rarely serious and, as the Maniases found out, easily remedied, even if the child does have to wear a band, a therapeutic helmet-like device designed to reshape the child's head over a period of time.

Possible Complications

The complications of this condition are generally cosmetic, according to Dr. Lewis First, Chief of Pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care and Professor of Pediatrics at the University of Vermont College of Medicine. "There are rare cases of facial problems resulting from severe asymmetry, including problems with vision, chewing, and eating, but these almost never occur, especially if the problem is recognized in the first few months of life," says Dr. First.

Dr. First feels it's important to note that the condition does not affect brain growth or cause developmental delay. "The simplest treatment is repositioning of the baby's head by simple maneuvers such as alternating the direction the infant is placed in the crib each night or moving the orientation of the crib so that the baby is not always looking out using the same head position each day," he says. "It is best to give the baby lots of 'tummy time' when [the baby is] awake to strengthen Baby's muscles in the arms, legs, and neck, as well as to reduce the external pressure on the back of the head."

Dr. First suggests having an X-ray taken if the problem persists during the ages of 4 to 6 months to make sure the bones of the skull are coming together properly. If the skull bones look normal, a custom molding helmet may be recommended to help redirect the skull's growth.