Straightening out plagiocephaly
Quincy Cunningham was 5 months old when his parents first noticed that the back right side of his head was beginning to look flat. Anthony and Lydia took their first-born son to his pediatrician, who indicated that Quincy appeared to have developed deformational plagiocephaly and referred them to Children's Hospital Boston for treatment.
Deformational plagiocephaly—a condition in which a baby's head becomes flat on one side—occurs in about 10 percent of otherwise healthy newborns. The flattening can occur at the front (deformational frontal plagiocephaly, or DFP) or the back (deformational posterior plagiocephaly, or DPP) of the head.
DPP is far more common. It occurs when the back of the head is flat on one side, the ear on that side is more forward, and there is minor flattening of the forehead on the opposite side. A diagnosis of deformational plagiocephaly is usually made through a physical examination, although it sometimes needs to be confirmed by X-rays.
Babies can be born with deformational plagiocephaly as a result of a tightened womb environment caused by multiple births, a small maternal pelvis or a breech position, but more often than not, the condition develops after birth. Several factors can increase a baby's risk, including torticollis (a congenital condition in which one or more of the neck muscles is extremely tight, causing the head to tilt and/or turn in the same direction), premature birth and back sleeping.
"Identifying torticollis, in particular, is key to early intervention," says Gary Rogers, MD, a plastic surgeon at Children's. "It's most commonly found in babies who are the first born, are part of a multiple birth, are male or are breeched—all of which can lead to constricted positioning in the womb. It's also often present in babies who are born prematurely due to their developmental delay." According to Dr. Rogers, pediatricians who suspect torticollis should immediately refer to a specialist.
He has also seen a rise in plagiocephaly cases since 1992, when the American Academy of Pediatrics recommended that infants be placed on their backs to sleep in order to reduce the risk of sudden infant death syndrome. "It's important to allow babies time on their stomachs while they're awake, but always with close supervision," he says.
Plagiocephaly is typically treated based on age. If the condition is identified early, when the child is age 3 months or younger, Dr. Rogers recommends using the head cup—a device placed under the child's head whenever he is lying on his back. "The head cup supports the child's neck and provides a hollowed out space that reshapes the head, allowing it to grow correctly," says Dr. Rogers, who invented the device. "As the child gets bigger, the NOPCO Brace Shop at Children's makes adjustments to the original molding." Children's is currently the only hospital that uses the head cup. Dr. Rogers is working on a commercial version of the device that he hopes to make available soon.
As a child grows older he becomes more mobile, so the head cup is no longer effective. For children like Quincy, who are already 4 to 5 months old when the plagiocephaly is detected, a molding helmet is recommended. Much like the head cup, the helmet is casted to fit the child's head and is adjusted as he grows. But the helmet is worn nearly 24 hours a day—with the exception of bath time—for a few months.
"Quincy wore his helmet for about two months," says Anthony. "He was a little unsure about it at first, but after a few days, he got used to it and did great." The Cunninghams saw marked improvement in the shape of their son's head during his time wearing the helmet. And today, at 22 months, you'd never guess that Quincy ever had plagiocephaly.
"As a child gets older, his head is less malleable, so it becomes less likely to achieve a completely rounded shape," says Children's neurosurgeon Joseph
Madsen, MD. "Of course, the goal with any plagiocephaly treatment is not perfection, it's improvement."
