Dear mum and dear dad you should know that the anomalies of the shape of the skull are extremely common and occur for several reasons, many of which are due to causes independent from parent behavior. The most common forms are Positional Posterior Plagiocephaly and Positional Posterior Brachycephaly. They may occur before, during or after birth.
What is positional brachycephaly?
Positional brachycephaly consists of a flattening of the entire back of the head.
If observed, therefore, the head appears shorter than normal, in fact the word Brachicefalia derives from Greek and means: short head.
What is Positional Posterior Plagiocephaly?
Positional Posterior Plagiocephaly consists of a flattening of the posterior, right or left part of the head.
The word Plagiocephaly comes from the Greek and can be translated with: oblique head.
Plagiocephaly can have different types of severity:
Initially only one side of the head tends to flatten: the area of the nape (type I). if the reason of flattening continues, the growth of the brain makes the bones of the skull closer. Both, internal that external bones, are pushed forward from the same side that is flattened. Therefore, the ears will not be positioned at the same height. The ear on the flattened side will appear from the outside more ahead of the other (type II). Subsequently, these bones will move the bones of the forehead , which will appear oblique with the highest part on the flattened side (type III), then the bones of the face and mouth for which the face will have an asymmetric appearance (type IV) and finally the skull will begin to grow upwards.
Baby boys have a bigger chances of being affected from Positional Plagiocephaly. In fact, two out of three children are male.
Also, for reasons related to the position that most children tend to take in the last months of pregnancy, 70% of newborns have a flattening on the right side of their head.
Causes of anomalies of the shape of the skull in newborns
Since the bones of the head are not yet welded, during fetal life and during the first months of life, the child’s head is extremely malleable. Therefore, there are a number of causes that can change its shape.
Before the birth:
The reasons that lead to a flattening of the head before birth are due mainly to a reduction of the normal abilities or possibilities of movement of the fetus inside the uterus. Therefore, the main reasons are:
- Very big baby (in particular male fetuses tend to be larger than female fetuses);
- Baby who, to get ready for birth, positions himself too upside down;
- Twin pregnancies;
- Shape of the uterus that pushes the child to position himself so as to rest his head;
- Reduction of amniotic fluid;
- Increase of amniotic fluid;
- A little elasticity of the uterus that does not allow the necessary enlargement during the pregnancy;
- Underweight child;
- Child who moves too little.
When if even only one of these conditions occurs, before birth, it is extremely easy for the child to have an alteration of the shape of the skull and / or to prefer to turn his head towards only one direction.
The head of the baby, in order to pass through the birth canal, must change its shape and become smaller.
In order to do this, the bones could move, flatten and even overlap. This is why babies’ bones are not welded. Therefore, frequently at birth bebies’ head may have a shape that adapts naturally to the uterine canal, for facilitating birth.
After 72 hours, head should however return to its round shape.
If this does not happen we are in the presence of a cranial deformity.
Also any cranial fractures, which may occur during childbirth, or the presence of large hematomas, caused for example by the use of the obstetric suction cup, can modify the shape of the head.
After the birth:
1. The newborn is kept for too many hours in the same position
Since 1992, the position in which pediatricians recommend to make babies sleep is the supine, that means – belly up. This has reduced the death syndrome in the cradle by 40% and so it should be necessarily used.
However, babies sleep several hours a day. Moreover, during the day, the newborn plays a series of activities that always take place in the same position: in fact, from supine, the child is changed and positioned in the bouncer or carrier when going out for a walk, and he is also transported in the car, without ever being moved, continuing to stay supine. Generally it is also held in a supine position by resting his head when in his parents’ arms.
Therefore, the head always tends to be kept on its back and therefore it is more easier that it gets flattened.
Another reason that causes the child to keep the same position for a long time is hospitalization. When babies are born very premature, a long hospitalization forces the child to always stay in the same position, as it is connected to pipes and machinery. This forced position could model the child’s head incorrectly.
2) Positional torticollis
80% of children with Plagiocephaly have neck muscles that have a difference in strength and of elasticity between the right side and the left side. This means that children prefer to keep always, or often, the head turned in the same direction. It is also possible that the head appears tilted into one direction rather than the other.
However, it is also possible that the child develops a preference towards one direction and consequently develops a difference in strength and elasticity between the muscles of the two sides of the neck if, after birth, most of the stimuli are in the direction that he prefers (e.g. mum sleeps on that side, the carillon is always on the same side, etc.).
Sometimes, by being able to better see his hand on the side to which he is usually turned, the newborn can begin to preferentially use that hand, neglecting the use of the other, and rolling only in that direction, creating further reasons for maintaining and preferring that position and riskin to use the rest of the body asymmetrically.
Development of Positional Brachycephaly after birth
If the baby spends too much time belly up, but the muscles of the neck have the same strength and then the head stays straight, the head will be crushed equally on the back side and the baby will then develop Brachycephaly.
Development of Posterior Positional Plagiocephaly after birth
If the baby, who spends most of the time belly up, will also have the tendency, for the reasons previously analyzed, to always be turned in the same direction, or if the child is always kept in the parents’ arms on the same side or always placed on the same side, the flattening in the back part of the head will be more evident on one side and Positional Plagiocephaly will develop. The longer the child spends in the same position, the greater the severity of the deformations.
It is of course possible that the reason why the child develops Positional Brachycephaly or Positional Posterior Plagiocephaly is due to the sum of previous conditions at birth with conditions related to childbirth and / or causes that have occurred after birth.
HOW TO HELP THE BABY
Ask to your Pediatrician
First of all, all the abnormal forms of the head should always be reported to the pediatrician, as Positional Plagiocephaly and Positional Brachycephaly can be confused with rare and severe brain and skull disorders.
It is also possible that sometimes the difference in strength between the neck muscles is caused by some neuromuscular system disorder, and therefore both positional stiff neck and non-symmetrical use of the legs and arms, should always be reported to the pediatrician.
In the case of Positional Plagiocephaly and Positional Brachycephaly, however, it is advisable to evaluate the need for manipulative intervention together with the pediatrician for pediatric rehabilitation in order to create a program of exercises and placements personalized for your child.
10 Tips to Prevent and Improve Brachycephaly and Plagiocephaly in the first months of life of your baby
The suggestions below, developed in 2014 by the Posture and Global Studies Center in collaboration with pediatric physiotherapists, developmental therapists, physiatrists and child neurosurgeons and kindly granted in vision, are extremely effective to avoid the flattening of the head, stimulate normal motor activity and prevent positional stiff neck that may occur after birth.
In case Plagiocephaly is already present, these tips should be applied trying to increase the number of exercises that aim to stimulate the child to turn from the side othat is pposite to the one that the baby prefers. Some possible situations can be created when playing or when holding the baby in your arms. In both cases, in fact, the child should be stimulated to use both sides and get used to the one affected by Plagiocephaly. If, for example, the skull has a greater lateral Brachycephaly the child should be accustomed to leaning on the opposite side too.
1) Keep the baby belly up in the cot and in the pram, from the first days, with a pillow in Memory-Foam and anti-suffocation with recess, which allows the correct development of the back of the head.
2) Keep the baby belly up alternating the position of the head between right and left side.
3) Since the baby is attracted by the presences and voices of his parents, if the child is asleep in your room, alternate the position of the carrier or bed according to the position of your bed, or move the baby’s bed so that your bed is alternately to the right and to the left of the child.
4) Removing the pillow, hold the baby, when he is supervised and awake, to the side alternating the right side with the left side, stimulating him with your presence or with objects that can catch his interest.
5) If there are carillons or games in the cot and / or carrier, change their position from central, to the right and to the left.
6) When you talk to the child and / or play with him, alternate your position between the central part, right side and left side.
7) Keep the baby in your arms, for any activity, including artificial feeding, changing the right arm with the left for the support of his head.
8) When in a straight position, to make him burp or to cradle it, alternate the use of yours right shoulder to the left one.
9) When awake, keep it as little as possible in cribs, baby carriages, and baby bouncers. When using these supports, make sure you have a comfortable Memory-Foam pillow with a hole that helps shape the skull. For transportation, the use of the baby wrap or baby carrier bag is preferred.
10) Starting with the 2nd month of life, when he is awake, well supervised and away from meals, start to position him on his stomach, on his arms, stimulating him to keep his head straight and to turn it towards you, right and left. If the baby initially cries, do not worry because for all children the first times can be a bit tiring. If you think this can help him, place a roll made with a rolled towel or pillows under the chest or arms trade for the Tummy time.
Hold it for a few minutes on your stomach and when you get tired change position, re-proposing the same activity later, during the same day, and increasing the time spent in this position by a few minutes each day. You will see that over time he will get less tired. Insist and do not be discouraged because it is essential that he acquires this capacity, for a correct general motor development and to improve the strength of the neck muscles. The child must also be stimulated from the 4th month to roll both to the right and to the left, and when he acquires the sitting position, from the 6th month onwards, to turn his head in both directions.