What is deformational Plagiocephaly?
Deformational Plagiocephaly is characterized by unusual flattening of an infant’s head and often a prominent or flattened forehead is visible. Plagiocephaly exhibits a variety of different head shapes, including flattening on one side of the back of the head with an asymmetric forehead, and brachycephalic head shapes that are flat across the entire back of the head with very prominent foreheads.
Is deformational Plagiocephaly more common than it used to be?
The incidence of deformational Plagiocephaly has increased since 1992 when the American Academy of Pediatrics recommended that parents place infants on their backs or sides to sleep in order to prevent Sudden Infant Death Syndrome. This highly effective program has dropped the SIDS rate in the United States and across the world by 40%. However, the additional time many infants spend in infant seats, car seats, and other supine (back) positions places them at risk to develop greater flatness and/or asymmetrically shaped heads. But this program alone is not responsible for the increased incidence. Other factors that may influence the development of deformational Plagiocephaly include: premature births, restrictive intrauterine positioning, cervical spinal abnormalities and/or birth trauma. Deformational Plagiocephaly is commonly seen in multiple births, affecting one or more siblings.
As many as 85% of the infants with deformational Plagiocephaly also have torticollis. This condition is caused by tightness or weakness on one side of the sternocleidomastoid muscle in the neck. When one side of this muscle is shortened, the infant’s head bends forward, tilts toward the shoulder on the affected side, and the face rotates toward the opposite shoulder. This muscle tightness or imbalance causes the head to rest consistently in the same position, creating areas of flatness on the back of the skull and compensatory growth in order areas of the head. Physical therapy is often prescribed to address torticollis. Home programs for stretching and massage of the affected muscle are very successful at addressing this problem.
Orthomerica has published a repositioning guide in english and spanish and a program called “Tummy Time Tools” to provide you with more information.
How do cranial remolding orthoses work?
The cranial remolding orthosis treatment program focuses on redirecting cranial growth toward greater symmetry. This is accomplished by maintaining contact over the prominent areas of the head, and allowing room for growth in the areas of flattening. This treatment has been used by medical professionals since 1979 when Sterling Clarren, MD wrote the first article about the use of cranial remolding orthoses for infants with deformational Plagiocephaly and torticollis.
How do I know if my infant needs a cranial remolding orthosis?
There are certain signs that may indicate that your infant needs a cranial remolding orthosis. However, please keep in mind that some degree of asymmetry in the skull is normal for everyone, so it is actually the magnitude of the asymmetry that indicates whether treatment with a cranial remolding orthosis is warranted. If you recognize that your infant’s face is not symmetrical, their head is higher or wider than normal, or that there is flatness on the back side of their head, you may want to visit your physician for further assessment.
What is the ideal age for cranial remolding orthosis treatment?
The best age for treatment is between 4 and 7 months when the skull is growing at the fastest rate. However, cranial remolding orthoses can be used successfully between 3 and 18 months of age. Caregivers should try to reposition for at least two months prior to initiating treatment with a cranial remolding orthosis unless the infant is older than 7 months. At this point, infants are able to reposition themselves, and caregiver efforts to reposition are often futile.
What if my pediatrician tells me that my infant’s head shape will correct on its own?
Historically, many head shape deformities present at birth disappeared within about 6 weeks because babies were placed in a number of different positions during the day and slept on their tummies at night. Since the Back to Sleep program was initiated in 1992, these head shape deformities often persist because babies sleep on their back all night and spend extended time on their backs during the day in infant carriers, swings, car seats, etc. Parents must be vigilant about changing the infant’s position more than in any other period of child rearing. Babies that spend most of their time on their backs in the early months roll and crawl later than usual, which results in even more time before the infant is able to actively reposition themselves. The best way to help your infant’s head correct “on its own” is to place your infant in a variety of positions during the time your infant is awake and supervised. This will encourage your infant to actively move their head through a full range of motion, strengthen their neck, shoulder and trunk muscles, and minimize pressure on the back of the head. More suggested repositioning activities are available in “Tummy Time Tools”, a document that can be downloaded from Orthomerica’s website. It is possible that your efforts to reposition your infant will be rewarded with a more symmetrical head shape that does not require further intervention. However, if your infant’s head does not change after two months of alternate positioning, make sure your pediatrician understands that you have tried prone and other positions to help make the infant’s head more symmetrical, and the skull has not corrected. Then ask your pediatrician if your infant would benefit from a cranial remolding orthosis, and/or request a referral to a craniofacial specialist.
Why is treatment more effective between 4 – 7 months than at other ages?
Even though the head grows fastest during the first 3 months of life, this time period is best spent actively repositioning your infant to encourage more symmetry. Between 4 and 7 months of age, the head grows about 1 cm per month*, and this rapid growth can be harnessed within the orthosis to produce rapid change in the desired direction of growth. At this point, the infant is starting to develop more head control and can tolerate the additional 6-8 ounces of weight from the helmet. It is actually the infant’s own growth that is the most active part of any orthotic treatment program. The orthosis is specially designed to make total contact in the areas of the skull where growth needs to be curbed, and allow space in the areas where growth is desirable. Between 8-12 months, the skull still grows quickly, but the rate is reduced to 0.5 cm per month*. Between 13-18 months, the rate drops below 0.5 cm per month*, and the skull begins to get thicker. Change is still possible in these older babies, but change is slower and generally requires longer treatment programs.
* Infant head growth charts are available at www.edc.com
Are there different kinds of cranial remolding orthoses?
Yes, there are different styles of cranial remolding orthoses. You may see pictures of various designs that are made with different kinds of plastic materials, with or without soft liners, with or without straps, with different colors or patterns, and with or without ventilation holes. Essentially, all cranial remolding orthoses work in a similar manner by directing growth of the infant’s head into a more symmetrical or proportionate shape. Currently, Orthomerica offers the widest variety of designs, including the STARband, STARlight (band, cap, and bivalve), and Clarren Helmet.
Why does Orthomerica manufacture so many different kinds of Cranial Remolding Orthoses?
The variety of designs and materials available from Orthomerica allows the practitioner to choose a design that will achieve the best results for the patient’s unique skull shape and circumstances.
Orthomerica’s cranial designs include:
STARband: This design is appropriate for all head shapes except scaphocephaly, which is a long, narrow head shape. The STARband is made of a plastic shell with 1/2″ foam liner. A mold of the infant’s head is modified at Orthomerica to produce a more symmetrical head shape. The practitioner sees the infant every two weeks (or more often during periods of rapid growth) and may shave additional material out of the STARband to allow space in the areas of flatness. The side and top openings make this a lightweight and easy to apply orthosis for caretakers, and is the most popular cranial design at Orthomerica because it is appropriate for so many different head shapes. The STARband is an active design.
This design was originally created to treat infants with scaphocephaly, a long and narrow head shape. The mold is usually modified to allow more space along the sides of the infant’s head where growth is desired, but it can also be modified in a variety of ways to manage other head shapes. It is made from clear plastic with a front and back shell held in place at the top, and has a Velcro( strap that fastens at the back of the orthosis. The clear plastic allows visualization of the areas of total contact and space, and can be altered with a heat gun to accommodate growth in specific areas. The STARlight Bivalved Orthosis is an active design.
This orthosis is made of clear plastic, and has side and top openings similar to the STARband. It is an extremely lightweight band, and is beneficial for very young babies, or for a infant who may need another orthosis for a short period of time until the infant is rolling or sitting up independently. The band can be heat-molded to accommodate growth and is an active design.
This orthosis is clear plastic and has no top or side openings. This is an effective orthosis for a variety of head shape and allows visualization of the areas of total contact and flatness. The band can be heat-molded to accommodate growth, and is an active design.
This design was originated by Sterling Clarren MD of Seattle Children’s Hospital in 1979 to treat infants with deformational Plagiocephaly. It is made from a plastic shell with a thin liner incorporated for comfort. All the modifications are built in to the helmet from the start, so follow up appointments are less frequent than with other types of remolding orthoses. This is the only Orthomerica design with a chin strap which helps to suspend the orthosis on the infant’s head. The Clarren Helmet is considered to be a passive design.