Prompted by numerous reports of babies around the country succumbing to Sudden Infant Death Syndrome (SIDS) as well as a strong desire to better inform parents about the potential dangers of placing newborns on their stomachs to sleep, the American Academy of Pediatrics (AAP) published a statement in 1992 recommending that healthy infants be placed on their backs for sleep.
Two years later, the AAP launched the nationwide Back to Sleep campaign to further promote supine (back) sleep positioning for newborns. The campaign has resulted in a significant decrease of SIDS—nationwide, rates have gone down by an estimated 40 percent in the last decade—yet there has been a marked increase in the diagnosis of positional head deformities in American newborns.
"Parents and healthcare providers need to be aware that supine positioning of the infant may result in flattening of the head," explains Robert E. Lyle, MD, associate professor, Department of Pediatrics, University of Arkansas for Medical Sciences and co-director of the Neonatal Intensive Care Unit at Arkansas Children's Hospital. Two of the most common types of positional head deformities diagnosed in newborns are plagiocephaly and torticollis.
Plagiocephaly is a condition that causes an infant's head to become misshapen, usually resulting with the flattening of one side of the back of the head, commonly referred to as positional plagiocephaly. (Plagiocephaly is a general term for cranial asymmetry, which basically refers to misshapen heads.) Cases of positional plagiocephaly can range drastically. Very mild cases may correct themselves with preventative measures and through repositioning exercises, while severe cases can require corrective surgery and/or the use of helmet therapy.
Congenital Muscular Torticollis
Congenital muscular torticollis, commonly known as torticollis, causes a newborn's head and neck to tilt to one side. "An involuntary one-sided contraction of the neck muscles can occur, resulting in an abnormal positioning of the head and limitation of the neck's range of motion," explains Dr. Lyle, who further emphasizes that torticollis may also present itself as a result of "bleeding or scarring in the major neck muscle, but can also occur due to the persistent positioning of the head to one side—such as may occur with the supine (back) positioning of the infant at sleep time."
Diagnosed cases of torticollis may occur in between 0.4 percent to three percent of babies, with those born prematurely more susceptible to developing this condition due to "critical illness that results in prolonged hospitalizations and the necessity for unidirectional positioning of the head, such as may occur when an infant requires a ventilator," explains Dr. Lyle. "Special care must be directed to alternate positions of the head even while ventilated to avoid this condition."