Preventing Skull Deformities (plagiocephaly)
In December, 2011(1) the Committee on Practice and Ambulatory Medicine, and the Section on Neurological Surgery of the American Academy of Pediatrics issued a clinical report on the prevention and management of positional skull deformities in Infants. Although flat or misshapen heads can occur for a variety of reasons, it is true that one of the consequences of the AAP’s 1992 recommendation for the use of the non-prone sleep position for infants, caused a dramatic increase in the number of babies with either unilateral or full flattening of the back of the head. Concern regarding the development of a flat or misshapen head is frequently cited as a reason why some are reluctant to use the supine sleeping position for their infant. This document was issued in part to help educate health care providers on how to distinguish between benign skull deformities such as those that occur from the supine sleep position to those related to a congenital condition called craniosynostosis or premature closure of suture lines that requires neurosurgical attention. Its other purpose was to give recommendations for parents on how to prevent significant skull deformities that can result from environmental influences.
To prevent the deformity, parents should be counseled during the early weeks of life to alternate the position of the head, from right to left, when the baby is sleeping and to periodically change the orientation of the infant while in the crib to outside activity (i.e to the door of the room) to encourage turning of the head in both directions.
When the baby is awake, and being observed, the infant should also have at least 30 to 60 minutes per day of tummy time. The purpose of tummy time is to ensure that for at least a portion of the day, the infant’s head is not subjected to forces that could contribute to ongoing molding of the head, and, in addition, promote the development of both shoulder and upper arm strength.
Prolonged placement indoors in car safety seats and swings should also be discouraged as these devices promote the supine position with continued pressure on the infant skull.
The risk for positional skull deformities is greatest during the first four months of life and generally shows improvement by 6 months of age as the infant becomes more mobile and is turning his head on a regular basis on his own.
Families may also be concerned that positional skull deformities contribute to developmental delay. There is some data that suggests that supine placed infants have some delay in acquisition of early motor skills related to upper body strength and rolling over, which resolve over time. There are no studies to date that suggest any relationship between positional skull deformity and long term motor or intellectual developmental delay, however.
- Prevention and Management of Positional Skull Deformities in Infants, Committee on Practice and Ambulatory Medicine, Section on Neurological Surgery; Pediatrics 2011;128;1236
