POSITIONAL PLAGIOCEPHALY PREVENTION

Positional Plagiocephaly is the most common positional head deformity and often presents with a parallelogram head shape when viewed from above. A positional head deformity is a condition that is caused by repeated external pressure applied to the same area of the skull. Due to the malleable nature of the infant skull, which allows for the head to mold during birthing, it is possible for repeated external pressure to cause the bones of the skull and face to shift, resulting in a head deformity and facial asymmetry.

The most disturbing fact about Positional Plagiocephaly is that the majority of cases are preventable. While it is true there are no steps that can be taken to prevent Positional Plagiocephaly from occurring in Utero, it is possible to prevent the majority of cases that develop after birth. Although we as parents have been told time and time again to keep our babies on their backs to reduce SIDS, the one thing we were not told is to vary the baby’s position so that the baby is not always resting on the same side of the occiput (back of the head).  The SIDS Alliance released a Media Advisory in September of 2001 that addressed SIDS prevention and reducing the risk of Positional Plagiocephaly.

The number one preventative measure of Positional Plagiocephaly is to vary the sleeping position of the baby. We as parents and caregivers need to be aware of how our babies sleep and take steps to ensure that equal time is spent on both sides of the occiput (back of the head).  In the early weeks, the baby will stay in the position that he is placed. For this reason, simply placing the baby’s head on alternate sides, left side, back, right side, each night will reduce the risk of Positional Plagiocephaly.  Before a child has the ability to roll, sleep positioners such as the Quilted Back-Sleep Positioning Wedge made by Especially for Baby, or the Curved Back Sleeper with Head Positioner made by Graco, may help to effectively vary your baby’s position. Once it becomes difficult to dictate the baby’s sleep position, crib toys should be placed on both sides of the crib to discourage the child from always looking in one direction. If this does not work and the child still favors looking in one direction then alternate the sleeping position by placing the baby’s head at the foot of the crib every other week. Most babies tend to turn in the direction that faces out of the crib toward the center of the room. Placing the baby’s head at the foot of the bed will allow the baby to look to the center of the room, but do it on the other side of the occiput.

When holding your baby in the crook of your arm, be sure to alternate arms to ensure that time is spent on both sides of the occiput.  If your baby is bottle fed, also be sure to alternate the arms that you hold your baby with during feeding to ensure time spent on both sides of the occiput. 

Being able to recognize the signs of Congenital Muscular Torticollis (CMT) is also important in prevention of Positional Plagiocephaly. If the baby tends to always turn in one direction or the head is always tilted to one side it is possible that Congenital Muscular Torticollis could be the cause. Although it is true that not every baby with CMT will have Positional Plagiocephaly, there is a high enough incidence rate of a baby having both disorders that parents should be able to recognize the warning signs and bring concerns up with the baby’s physician. 

The next preventative measure is “tummy time” during play. We as parents and caregivers have strayed from this important practice. When your baby is awake and is being supervised there is no reason why the child should not be allowed to play on his or her stomach. When tummy time is first introduced to a baby, it is best done is short intervals of only about a minute or two at a time. As the baby gains muscle control and begins to enjoy tummy time, the intervals can be increased. This not only has the benefit of allowing an infant to strengthen many muscles that are not used when laying on the back, but it also allows the back of the head to have some time without external pressure pushing up against it.

Finally another preventative measure concerns the extended use of car seats (used as a carrier), infant carriers, bouncy seats and infant swings. Be aware of how much time your baby spends in any of these devices. The convenience of these items should not tempt parents or caregivers into using them for the majority of the baby’s day. If your child spends close to 100% of his or her day in one or more of these devices, then appropriate steps should be taken to lessen this by holding the baby more, using a soft sling or carrier to carry the baby, and by including supervised tummy time during play. If these items must be used for extended periods of time be aware of the direction that the child looks in. If the child tends to look in one direction change the placement of the device to offer more stimulus on the side that the baby tends not to look.

An Important Note Concerning The Back to Sleep Campaign: It must be stated that the Back to Sleep Campaign has made tremendous strides in saving our children from SIDS. Please do NOT abandon this campaign due to fears concerning Positional Plagiocephaly. The Back to Sleep Campaign can still be achieved and the risk of Positional Plagiocephaly reduced by simply alternating the sleeping position of the child, adding supervised “tummy time” during play, and by being aware of which direction the child tends to look. 

Please visit our printable materials section to obtain a handout about Positional Plagiocephaly Prevention.

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The information on this website should not be used for medical advice.  Medical or health advice should be provided only by medical or health professionals.

©Craniosynostosis And Positional Plagiocephaly Support, Inc.2001