The "Epidemic" of Deformational Plagiocephaly

The Back to Sleep Program is regarded as one of the most successful programs ever initiated by the American Academy of Pediatrics. The rate of sudden infant death in the United States has decreased over 40% since the program's inception in 1992, saving thousands of infants' lives. Supine positioning for sleep, keeping the child cool at night, discontinuing smoking at home, eliminating shared bed sleeping and using a pacifier for naps and nighttime sleeping have been found to reduce the incidence of sudden infant death. However, an unintended consequence of the program is the increase in the number of infants who acquire skull deformities secondary to extensive time spent on their backs at night coupled with an inappropriate amount of time supine when babies are awake. Fortunately, parents are no encouraged to reduce the time in infant positioning device and to place their babies prone as much as possible when awake to prevent head shape deformities and to encourage normal development.

Parents are naturally concerned if they observe asymmetry or unusual flat spots on their baby's head, and often seek advice from their pediatrician. Treatment interventions include repositioning, a developmental home program, physical therapy, and/or the use of a cranial remolding orthosis, such as the STARband, to improve symmetry and normal proportion. 

Why are the Skulls of Infants Subject to Deformation?

  • The plasticity of the newborn's skull makes it susceptible to external pressures in the womb, during the birth process, and after birth.
  • The immobility of newborns and any positional neck preference can predispose infants to extrinsic skull deformities. 
  • Intrinsic abnormalities can be caused by craniosynostosis or through genetic transmission. 
  • Deformational forces most frequently affect the occiput, although the frontal bones and the face may be affected in severe cases 
  • About 24% of babies have some type of noticeable skull deformity at birth, reducing to about 20% by 4 months of age.
  • The abnormal shape may persist if the baby spends most days on the back against the hard surface. 

What are Contributing Risk Factors for Deformational Plagiocephaly?

  • Prolonged supine positioning
  • Lack of time on the tummy when the baby is awake.
  • Congenital Muscular Torticollis, neck weakness or restricted neck range of motion.
  • Males more frequently develop deformational plagiocephaly at a rate of 2:1. 
  • Slower motor development particularly gross motor skills.
  • Breech or transverse presentation in utero.
  • Multiple birth infants.
  • Visual field deficits.
  • Bony abnomality in the cervical spine.
Torticollis and supine position are risk factors.

Torticollis and supine position are risk factors.