Early Intervention Is The Key To Correcting Deformational Plagiocephaly
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Dr. Jean-Francois Lefaivre explains how an orthotic band reshapes the head as a baby grows.

Mommy rocks her newborn to sleep and lovingly places the baby on his back in the crib. While this sleeping position decreases her child’s risk of Sudden Infant Death Syndrome, it may increase the likelihood of deformational plagiocephaly, a condition in which his head develops an uneven shape and flattening in the back of the skull.

Because more parents are following guidelines since the early 1990s to lay babies on their backs, the incidence of deformational plagiocephaly has risen significantly since then. When an infant spends extended periods of time in this position, whether it be in a crib or an infant carrier, the pressure put on the back of the head can cause the soft skull to deform. Certain factors before birth can cause pressure inside the uterus resulting in deformational plagiocephaly, and another major contributor in recent years has been the rise in multiple pregnancies from fertility medications.

Fortunately if identified early, deformational plagiocephaly can be treated relatively easily. Dr. Jean-Francois Lefaivre, Assistant Professor to Associate Professor of Surgery with extensive craniofacial experience, is referred one or two babies a week with this condition. In addition to the flattening in the back of the head, the babies appear as if half of the head has been pushed forward and often display facial asymmetry, a bulging forehead and misaligned ears. “Timely screening by pediatricians and early intervention is the key,” said Dr. Lefaivre. “If an infant has some degree of flatness to his head, the primary care doctor may say that it will get better on its own. Yet things do not always get better without some degree of intervention,” he said.

In younger babies, simple measures implemented by parents can sometimes correct the problem. “Babies can be placed on their bellies while they are playing, such as when they are using an activity gym on the floor,” said Dr. Lefaivre. Range of motion exercises may be prescribed to stretch tight neck muscles that left untreated can contribute to the deformity.

When additional intervention is needed, infants can be fitted with a customized orthotic band that fits around the head. The bands, which are to be worn 23 hours a day for a number of months, are constructed of a plastic shell with a foam lining that reshapes the infant’s head as it continues to grow. “The band does not squeeze the head. The last thing you want to do is put compression on a growing head because the underlying brain is growing,” explained Dr. Lefaivre. The bands work best when babies are three to five months old since much of their growth occurs in these first few months of life. “If you refer a baby at ten months, then either the correction is less or will take a longer amount of time,” he said.

When parents bring babies to Dr. Lefaivre for follow-up after three or four months, he evaluates the current appearance of the head to a model that was constructed to make the corrective band. “You can look at the initial shape and compare; what you see is a whole lot of rounding of a flat surface,” he said.

Reprinted from Connections newsletter, November 2002

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