This will encourage more active head turning. Turn the pram so that the child is facing forward towards the world to enhance visual and audio stimulation.If bottle feeding, alternate the preferred feeding arm that the baby lies in, so that the baby must turn their head more towards the bottle.Alternate the baby’s head position during day sleeps it is important to note that the use of pillows in the cot is not recommended as this is not SIDS safe.Conservative strategies for the management of deformational plagiocephaly If the GP finds neck tightness suggestive of torticollis, referral to neonatal or paediatric physiotherapy can provide stretches that may be effective (Box 1).īox 1. Torticollis can lead to occipital flattening on the opposite side of the head to the neck stiffness. This can cause the child to have a head tilt or turn preference. Torticollis is a condition in which the sternocleidomastoid muscle is tight resulting in an abnormal neck posture. Torticollis may also be associated with deformational plagiocephaly. Counter-positioning measures include increasing tummy time and moving the cot or placing a night light so that the infant is encouraged to look in the direction opposite to their neck turning. Surgery is almost never indicated for deformational plagiocephaly, so differentiating it from craniosynostosis is very important.Ĭonservative management for deformational plagiocephaly consists of counter-positioning and physiotherapy. 9,10 Deformational plagiocephaly is self-limiting, and the head shape begins to improve as the child grows and spends less time lying down. Some craniosynostosis forms, notably unilateral lambdoid synostosis, may produce a similar head shape to deformational plagiocephaly, and differentiating between them can be challenging. Deformational plagiocephaly arises as a result of repeated external pressure to an infant’s skull for an extended time period before or after birth, 7,8 for example, sleeping supine without altering position. 6 Deformational plagiocephalyĭeformational plagiocephaly is the most common cause of abnormal head shape and an important differential to consider in all infants with head shape abnormalities. There are over 200 known craniosynostosis-associated syndromes including Muenke, Apert and Crouzon syndrome. 5 It frequently involves multiple sutures, and children present with a wide range of affected extracranial organ systems. Syndromic craniosynostosis is rarer and accounts for between 9.9% and 18.3% of all craniosynostosis cases. The pathogenesis may involve developmental errors during embryogenesis, intrauterine skull compression, genetic factors and/or teratogens. 4 The cause of craniosynostosis is incompletely understood, but the condition is believed to occur early in gestation. 3 The most common presentation is when only a single suture, most commonly the sagittal suture, is involved. It can involve one or more sutures and can present with a wide range of head shapes depending on the sutures affected and the extent of fusion. Non-syndromic craniosynostosis arises without extracranial dysmorphisms. Occurring in one in 2000–2500 live births, 1,2 craniosynostosis is a heterogeneous condition classified as either non-syndromic (arising as an isolated issue in an otherwise healthy infant) or syndromic (occurring with multisystem extracranial anomalies). The various distinctive head shapes in the axial plane showing types of craniosynostosis, and deformational plagiocephaly 1 This results in distinctive head shapes (Figure 1), which can help determine the involved suture(s) and lead to a diagnosis. Craniosynostosis is the premature fusion of one or more cranial sutures, which causes skull growth restriction in the plane perpendicular to the involved suture, with compensatory overgrowth parallel planes. CraniosynostosisĬraniosynostosis is the most common paediatric skull deformity requiring specialist craniofacial intervention and often initially presents as an abnormal head shape. GPs play an important part in providing first-line assessment, reassurance and referral if craniosynostosis is suspected to allow time-sensitive treatment options to be considered. Parents with concerns regarding their child’s head shape often first present to general practitioners (GPs). Consequently, newborn head shapes are challenging to assess accurately. Newborn head shapes are varied and influenced by intrinsic factors such as parental head shape, sex and ethnicity, and external factors including fetal moulding, prematurity, prolonged labour and instrumented deliveries. There is a wide spectrum of normal head shapes, and parental concern regarding the shape of their infant’s head is common.
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