Dear Mum and Dad, you should know that skull shape anomalies are extremely common and occur for a variety of reasons, many of which are due to causes unrelated to parental behaviour. The most common forms are anterior positional Plagiocephaly and anterior positional Brachycephaly and can occur before, during and after birth.
What is positional brachycephaly?
Positional Brachycephaly consists of a flattening of the entire back of the head. When observed, the head appears shorter than normal. In fact, the word Brachycephaly comes from the Greek and means: short head.
What is posterior positional plagiocephaly?
Posterior positional plagiocephaly is a flattening of the right or left rear part of the head.
The word Plagiocephaly comes from the Greek and can be translated as: oblique head.
Plagiocephaly can present with different types of severity:
At the beginning, it tends to flatten only one side of the head: the neck area (type I), if the reason for the flattening continues, the growth of the brain causes the bones of the skull, both internal and external, to be pushed forward on the same side that is flattened, the ears will then no longer be at the same height for which the ear on the flattened side will appear from the outside to be further forward than the other (type II). Subsequently, these bones displace the bones of the forehead which will appear oblique with the higher part of the side that is flattened (type III), then displace the bones of the face and mouth where the face will have an asymmetrical appearance (type IV) and finally the skull will start to grow more upwards.
Male children are more likely to have positional plagiocephaly; in fact, two out of three children are male.
In addition, for reasons related to the position that most babies tend to adopt in the last months of pregnancy, 70% of newborns have a greater right-sided head crush.
Causes of skull shape anomalies in newborns
As the bones of the head are not yet fused, during foetal life and the first few months of life, the baby’s head is extremely malleable, so there are many causes that can change its shape.
Pre-natal causes :
The reasons that lead to head crush before birth are mainly due to a reduction in the normal ability or possibility of movement of the fetus in the womb, the main reasons being
- Very large baby (male fetuses in particular tend to be larger than female fetuses);
- Baby who, in preparation for birth, is placed too soon upside down;
- Twin pregnancies ;
- The shape of the uterus that pushes the baby into a position where it can rest its head;
- Reduction of amniotic fluid ;
- Increased amniotic fluid ;
- A lack of elasticity of the uterus which does not allow for the necessary enlargement during pregnancy;
- Underweight baby ;
- A little baby that moves.
When only one of these conditions is present, it is extremely easy for the child, already at birth, to have an altered skull shape and/or to prefer to turn the head in one direction.
Causes related to childbirth :
- The baby’s head, in order to pass through the birth canal, must change shape and become smaller.
- For this to happen, the bones that are not fused in the baby before birth for precisely this reason can move, flatten and even overlap. It is therefore common for the baby’s head at birth to have a shape that fits naturally into the uterine canal to facilitate delivery.
- After 72 hours, however, they should return to their more rounded shape.
- If this is not the case, we are dealing with a cranial deformity.
- Possible skull fractures, which may occur during childbirth, or the presence of large haematomas, caused for example by the use of a vacuum pump, can also change the shape of the head.
Causes after birth:
Keeping the baby in the same position for too many hours.
Since 1992, the position in which paediatricians recommend that newborns sleep on their backs or stomachs has been the norm. This method has been shown to reduce Sudden Infant Death Syndrome by 40% and should therefore be used.
A newborn’s sleep takes up several hours of the day. In addition, during the day, the infant performs a number of activities that always take place in this position:
In fact, in the lying position, the baby is changed and placed in the baby carrier or pram, goes out for a walk, and is also transported in the car, without ever being moved, by lying down. In general, the baby is also kept in the lying position, with its head resting on the parent’s arm.
In any case, the head always tends to be flattened at the back, so it is easier for it to flatten.
Another cause of keeping the baby in the same position for a long period of time is when the baby is hospitalised. When the baby is born very premature, a long hospitalization forces the baby to stay in the same position all the time because it is connected to tubes and machines. This forced position can give the baby’s head a bad shape.
80% of children with plagiocephaly have neck muscles that differ in strength and elasticity between the right and left sides, so that children prefer to keep their head turned in the same direction all the time, or often. It is also possible that the head appears to be tilted in one direction rather than the other.
This almost always happens because the baby, even in the womb, has been turned, for the reasons described above, to the same side to which, after birth, it prefers to stay or move.
However, it is also possible for the baby to develop a preference for one direction and therefore a difference in strength and elasticity between the muscles on the two sides of the neck, if after birth most stimuli are in the direction he prefers (e.g. the mother sleeps on this side, the music box is always on the same side, etc.)
Sometimes, with a better view of the hand on the side to which it is usually turned, the newborn may begin to preferentially use that hand, neglecting the use of the other, and roll only in that direction, creating further reasons to maintain and prefer that position and risking asymmetrical use of the rest of the body.
Development of positional brachycephaly after birth
If the child spends too much time on its stomach, but the neck muscles are equally strong and the head therefore remains upright, the head will also be crushed on the back side and brachycephaly will develop.
Development of posterior positional plagiocephaly after birth
If the child, who spends most of his or her time on his or her stomach, will also tend, for the reasons analysed above, to be always turned in the same direction, or if the child is always held on the same side or positioned on the same side, crushing of the back of the head will be greater on one side and plagiocephaly in a posterior position will develop. The longer the child is held in the same position, the more severe the deformity.
It is of course possible that the reason why the child develops positional brachycephaly or posterior positional plagiocephaly is due to a combination of prenatal conditions with birth-related conditions and/or postnatal causes.
How to help your child
Talk to the paediatrician
Any abnormal head shape should always be reported to the paediatrician first, as positional plagiocephaly and brachycephaly can be mistaken for rare and serious brain and skull disorders.
It is also possible that the difference in strength between the neck muscles is caused by pathologies of the neuromuscular system. Therefore, positional torticollis and non-symmetrical use of the legs and arms should always be reported to the paediatrician.
In the case of positional plagiocephaly and positional brachycephaly, however, the need for paediatric manipulation and rehabilitation should be assessed with the paediatrician in order to create a personalised exercise and positioning programme for your child.
10 tips to prevent and improve brachycephaly and positional plagiocephaly in the first months of life
The following tips, developed in 2014 by the Center for Posture and Global Studies http://www.studioposturaeglobalità.it/ http://www.plagiocefaliaposizionale.it/ in collaboration with pediatric physiotherapists, developmental therapists, physiatrists and child neurosurgeons and kindly granted for consultation, are extremely effective in avoiding head flattening, stimulating normal motor activity and preventing positional torticollis that can occur after birth.
In cases where plagiocephaly is already present, this advice should be applied by trying to increase the number of exercises aimed at stimulating the child to turn to the side opposite to the one he/she prefers. Possible situations are: during play and when held in the arms. In both cases, the child should be stimulated to use both sides and to get used to the side affected by the plagiocephaly. If, for example, the skull is more laterally brachycephalic, the child should be trained to bend to the opposite side.
1) Keep your baby on his or her stomach in the bed and pram from the very first days, with a memory foam and anti-suffocation pillow with a cavity, allowing the correct development of the back of the head.
2) Hold the baby on its stomach, alternating the position of the head between the right and left sides.
3) As the child is attracted to the presence and voice of the parents, if the child is sleeping in your room, alternate the position of the pram or cot in relation to your bed or move the child so that your bed is alternately on the left and right side.
4) When removing the pillow, hold the child, when supervised and awake, on his or her side, alternating between the right and left sides, stimulating the child with your presence or with objects of interest.
5) If there are music boxes or toys in the bed and/or pram, alternate their position between the middle, right and left.
6) When talking to your child and/or playing with him/her, alternate your position between the middle, the right and the left.
7) Hold the baby for any activity, including artificial feeding, using the right arm alternately with the left to support the baby’s head.
8) When upright, to burp or rock the baby, alternate the use of your right shoulder with your left.
9) When the child is awake, keep him or her as little as possible in a crib, pram, sling or carrier. When using these carriers, make sure you have a comfortable memory foam pillow with a hole in it to help shape the skull. Use a sling or baby carrier for transportation.
10) From the 2nd month, when the baby is awake, well supervised and away from feeding, start holding him on his tummy, supporting him on his arms, encouraging him to keep his head upright and turn it to the right and left. If the baby cries at first, don’t worry, as for all babies the first few times can be a bit tiring. If you think it will help, place a roll of rolled up towel under the baby’s chest or arms or the tummy time pillows available on the market.
Keep him on his tummy for a few minutes and when he gets tired, change the position, offering the same activity later in the day and increasing the time he spends in this position by a few minutes each day. You will find that over time he will tire less and less. Insist and don’t be discouraged, as it is essential that they acquire this ability, for correct general motor development and to improve the strength of the neck muscles. The child should also be stimulated from the 4th month onwards to roll to the right and to the left, and when it acquires a sitting position, from the 6th month onwards, to turn its head in both directions.