Deformational plagiocephaly is the most common type of head shape deformity in newborn babies. It is popularly known as the Flat Head Syndrome. It is an abnormal shape of the babies’ heads due to external factors. Asymmetric deformity of the head can be seen at birth or in the first few months following birth.
Parents, elderly members of the family, or a pediatrician, often notice it during routine controls. Characteristic features are flatness on either the right or left side of the back of the head, and a forward protrusion on the forehead on the same side. The ear shifts forward due to the flat spot behind the head. In some babies, when looking at the face, asymmetry in the eyes, jaw, teeth, nose, and cheeks can be seen with the naked eye.
There is a strong connection between plagiocephaly and tight neck muscles of infants. Research reveals that 85-90% of infants with tight neck muscles have plagiocephaly. Tight neck muscles usually start in the uterus before the baby is born. For instance, if a baby enters the vaginal canal early, the baby remains constricted to a limited space for a prolonged period. This can cause the neck muscles to become stiff. This is also true when twins are sharing limited space. The neck muscles continue to be tight after birth. In addition, the deformity of a baby’s head increases day by day due to the malleable bones, the growing brain, and the force of gravity in the early months.
To prevent head shape deformity, start positioning your baby on their back as soon as they are born. Do prone activities often while they are awake and supervised. There is no limit to the frequency of these activities. Increase the frequency and duration slowly each day. The more frequent and long-lasting, the better! By doing these activities, you will prevent possible deformities that may occur in your baby’s head as well as support your baby’s motor development.
Tightness of the neck muscles is the primary reason why a baby does not respond to repositioning. Despite your repositioning efforts, if your baby persistently chooses to sleep with their head turned to the left or right, the baby most likely has a tight neck muscle problem as mentioned above. In addition to repositioning and using exercise methods at home, it is necessary to get help from a physiotherapist.
Certain conditions must be met to start the STARband helmet treatment.
The Severity of Head Shape Deformity
Your baby’s age
Repositioning and its effectiveness
Physical Therapy for tight neck muscles or torticollis
In 2016, the American Academy of Pediatrics (AAP) issued new evidence-based guidelines on how to manage deformational plagiocephaly and other head shape abnormalities. These were an update of guidelines from 2003. In the 2016 new guidelines, studies that were conducted after 2003 were reviewed. The recommendations related to repositioning, physiotherapy, and helmet therapy still apply. The AAP issued recommendations are always strictly monitored by STARband.
STARband helmets were the preferred cranial orthoses used in many studies. For these studies, the STARscanner data acquisition system was also preferred both for determining the severity of the deformity and for monitoring treatment with comparative measurements. The STARscanner is preferred by many researchers because of its consistent and accurate measurements in conjunction with the FDA approved STARband helmet.
The Plagiocephaly Severity Table prepared by Children’s Healthcare of Atlanta was also used in this research.
Research shows that the ideal time to start STARband helmet treatment is between 4-6 months. For the best possible success of treatment, it is not recommended to wait until 10-12 months. At CRANIAL, the data we have obtained from our patients also shows that the ideal time to begin treatment is between 4-6 months. When treatment starts after one year old, the growth rates of the brain and skull significantly slow down. Therefore, the treatment lasts much longer. Due to these factors and depending on the severity of the deformity, it may not be possible to achieve the target improvement. Nevertheless, satisfactory, and visible improvement can still be achieved by the effectiveness of the STARband helmet treatment program.
As mentioned above, the Plagiocephaly Severity Scale Table is important for identifying the severity of deformities in the heads of infants. Another important factor in identifying the severity of plagiocephaly is measuring the head shape using a reliable scanning system. The STARscanner provides highly accurate, reliable results. The report from the STARscanner objectively determines if your baby's head shape deformity is mild, moderate, or severe. At the same time, the report provides more detailed information such as 3D images of different views and a numerical comparison of the asymmetry in various levels. This includes to what degree plagiocephaly affects your baby's head, how much the ears have shifted, and the degree of asymmetry of the eyes and nose. The STARscanner not only determines the severity of plagiocephaly, but also monitors the response of your repositioning efforts, and the results of your STARband helmet treatment effectiveness. This can be done comparatively at any point during the treatment with your cranial technician and your doctor.
How is the severity of deformational plagiocephaly determined? For severe skull deformations, it is recommended to start the STARband helmet treatment right away without attempting repositioning, regardless of your baby’s age (except for the condition of being older than 3 months). Studies have shown that babies with severe deformational plagiocephaly would still have at least a moderate deformity after 6 months, despite repositioning. Especially in infants with severe plagiocephaly, asymmetry is more prominent in the ears, face, and forehead. Therefore, treatment of head shape abnormalities with severe severity should be started without attempting repositioning. This saves valuable time, which allows the deformity to be corrected to a near normal shape as well as shortens the duration of treatment.
In these infants, there is a high probability of tight neck muscles as well as plagiocephaly. For this reason, the STARband helmet treatment should be started with the help of a pediatric physiotherapist. In other words, physical therapy and the STARband helmet treatment should be continued simultaneously.
For moderate deformational plagiocephaly, if your baby is less than 6 months of age, it is recommended to position the head in the supine position and do exercises and supervised prone activities (i.e. tummy time) for one or two months. After that, comparative reports are taken with the STARscanner to find out if there has been enough improvement of the deformity. The extent of the treatment and the adequacy of the response are evaluated. If the deformity of the head is sufficiently improved and becomes mild, the activities are continued. However, if the deformity is still moderate, then STARband helmet treatment should be started.
Infants with moderate plagiocephaly are also likely to have tension and tightness in the neck muscles. Again, as with severe head shape abnormalities, it is required to get help from a pediatric physiotherapist.
Mild head shape deformity does not require STARband helmet treatment. Deformational plagiocephaly of mild severity is seen in many babies and is reversed in a short time by repositioning, doing simple home exercises and prone activities.
Parents can easily confuse moderate and severe head shape abnormalities with mild severity abnormalities. Often, they listen to the advice, ‘It will get better and it will disappear in time’.
It should be noted that no one's head is perfectly symmetrical. What makes a head shape abnormal is the severity of asymmetry.
Find out the severity of the deformity of your baby's head with the STARscanner!