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Deborah Howell (Host):  Welcome. Well it looks like we’re going to have a baby boom this October. And a lot of new parents will surely be asking, why is my baby’s head flat? And that’s our topic today. My guest is Chelsea Julian, a Pediatric Physical Therapist at Highpoint Therapy at Deaconess the Women’s Hospital. And she works with young families whose babies develop plagiocephaly. Welcome Chelsea.

Chelsea Julian, DPT:  Hi Deborah. How are you?

Host:  Excellent. So, glad to talk to you today.

Chelsea:  Great, I’m happy to be here.

Host:  Good. Well let’s dive right in then. What is positional plagiocephaly?

Chelsea:  Positional plagiocephaly has a lot of different terms of how you can say it or diagnose it. so, it can be plagiocephaly, flat head syndrome, and then there’s also brachycephaly which is kind of similar to the plagiocephaly as well. But what that is, is it’s just a deformation of the skull and how it is formed. It can be caused prenatally and there are postnatal factors that can cause some differences in a baby’s head shape.

Host:  And parents of course will be asking will my baby be okay and what do you tell them?

Chelsea:  So, first of all, yes, your baby is going to be just fine. What I usually try to tell parents is just that early intervention is the key and that’s the key for almost all pediatric diagnoses is early intervention. But there are so many different things that we can do to help with a baby’s head shape and also help with their growth and fine motor development as well.

Host:  Well that’s excellent news. Now is plagiocephaly common?

Chelsea:  Plagiocephaly is very common. It’s actually more common than you would think. One in three babies actually have some form of skull distortion and that’s straight from the Academy of Pediatrics website. So, one in three. That’s a lot.

Host:  That does surprise me really. And so at what age does plagiocephaly develop?

Chelsea:  So, this is something that can happen like as soon as a baby is born. Some of those risk factors that can happen then may just be like was there twins, was there triplets, uterine crowding, low fluid, a prolonged labor, born prematurely; all of those things can significantly affect a baby’s head shape because babies heads have to be super moldable to be delivered. Those soft spots and those suture lines are very open just to help them to come out of the birthing canal. So, it can happen as soon as day one. But there’s also a difference. There’s cranial molding as well and that tends to happen so you can have a baby born with like a cone head of something just after a vaginal delivery. And that sometimes can last up to six weeks but other times if they have an associated torticollis which is a muscle shortening in the neck at birth, then that can lead to some of that positional plagiocephaly and deformities.

Host:  Understand. Now why does the flattening occur?

Chelsea:  Flattening occurs if it’s in utero then like I said before, it’s because of that like a crowding in the uterus or low fluid or that prolonged labor. But after the fact, there’s actually been a big increase in the prevalence since Back to Sleep. So, to prevent SIDS, that’s the safest way for babies to sleep is on their backs. So, a lot of times, you get those kids that are really good sleepers that they tend to have a flatter head because they spend a lot of time on their backs. Luckily, my kids never had that because they never sleep, and they are four and two right now and they still don’t sleep.

So, yeah, it’s caused by those external like weightbearing forces on their head too after they are born if that occurs.

Host:  That just makes total sense. Now why is it that only some infants develop plagiocephaly?

Chelsea:  So, it kind of depends on what daily routines are. Some babies just naturally have a head preference towards one side so, whenever they’re in their swing or if they are laying down in their crib; they always have their head to the right. Another thing that can cause that is most adults are right handed, so whenever they change their diaper or they are feeding them a bottle, then they always position them so that they can use their right hand more fully so that way their head is to the right constantly like doing those things.

And then feeding a baby sometimes takes about 30 minutes so, if you do that eight times a day, 30 minutes, that their head is over towards the right. So, it just makes them prefer that side a little bit more. So, one of those main keys with that in prevention is that repositioning and making sure that we’re rotating them through positions in the crucial age of that less than six months.

Host:  This is absolutely fascinating. When does the flattening process stop?

Chelsea:  So, babies’ heads are not fully formed until like 19 months to two years old sometimes. So, that’s when those soft spots start to go away and get smaller and then we have less mobility of the skull.

Host:  Less mobility. Maybe you can elaborate on that a little.

Chelsea:  What that means is that their head isn’t going to mold as much based on what position they are in because those sutures have closed and there’s not as much opening in the skull for it to be able to move. And the other thing is, typically your 18 month old is running around and jumping and playing so that the only time they are on their head is when they are asleep. So, they are much more active and more upright. That’s why it’s so crucial for those babies that are zero to four months old to make sure that they are getting tummy time and make sure that they’re only on their backs to sleep and when they are sleepy so that they get decreased weightbearing on their head and it allows their head to grow in that more symmetric shape.

Host:  Right. Chelsea can the flattening be prevented?

Chelsea:  Yes. Flattening can be prevented and there’s several different ways that I like to talk to parents about that are great ways to work on this. We give it a blanket term of like a repositioning program and the main thing in that is tummy time. Do you know what tummy time is?

Host:  Ah, I had some last night when I was trying to get to sleep.

Chelsea:  So, you are allowed to sleep on your belly because you are an adult. But kids are not. So, we like to give the statement of Back to Sleep and Tummy to Play. So, they need to have that tummy time so that not only they can progress those gross motor skills and learn to push up and roll over and have that head control but it also gives them time where they are not weightbearing on the back of their head or giving in to that head preference where they go to one side or the other.

Host:  Got it. Okay. Now does plagiocephaly cause any medical problems?

Chelsea:  So, it can definitely lead to that have a plagiocephaly or even a brachycephaly which is that flattening of the back of their head, it can lead to overall gross motor delay, poor tolerance to bringing – you know getting midline with their hands and midline to play. It also limits their ability to roll over to one side or the other or roll belly to back and back to belly.

Host:  And here’s something I’ve always wondered because you always see them put together in the same sentence. What’s the difference between plagiocephaly and craniosynostosis?

Chelsea:  That big difference is plagiocephaly is typical of that positional flattening of on side of the head or the other based on what baby’s preference is. Craniosynostosis is actually that premature fusion of the sutures in the skull. So, whenever that happens, we don’t have any mobility of that skull even if they are doing tummy time 24 hours a day. Their head is going to stay in that same shape because there are no soft spots or those suture lines that can allow for that mobility of the skull.

Host:  Got it. And the number one question we always get from parents is will my child need surgery.

Chelsea:  So, surgery is kind of a different ballgame with that. The very first step if we have a baby that comes in for an evaluation because they have a flat head or a plagiocephaly is that repositioning. We don’t talk about surgery unless they do have a significant craniosynostosis or if they have a significant torticollis in which they have like a mass on the muscles of their neck that can cause them like they cannot turn their head to the opposite side because that muscle is so tight and so short.

Host:  Well if not surgery, then will my child need physical therapy?

Chelsea:  So, physical therapy would be a great asset to any baby that has a plagiocephaly. Always that first step is getting your pediatrician involved and they can advise you on kind of where to go from there. I see so many kids every week that are two months old to ten months old that come in because they have a referral from their pediatrician to come in and start on some stretches and learn a repositioning program that’s specific for them. The other thing that we haven’t really touched on is those cranial orthoses which is like the helmet that you would see. So, anytime that might be needed, it is required by insurance, most insurances eight to twelve weeks of repositioning which would be from a physical therapist.

Host:  Okay. I have just two more questions for you Chelsea. First, how do we help and prevent positional plagiocephaly?

Chelsea:  To prevent a positional plagiocephaly, what we want to do is make sure we’re giving our babies adequate tummy time. So, that means when they are awake, they are on their tummies to play. You can start tummy time that day you come home from the hospital. And when the babies are younger, they are a little bit more sleepy so anytime they get sleepy, we do want to get them on their side or back on their back but if they are awake and ready to play, then you get them on their tummy whether that be on your chest or on your lap or on the floor, over a boppy, anyway that they will prefer it even if it’s for a minute. As they get a little bit older and get more used to it, they can tolerate a little bit longer, but one minute of tummy time is better than no minutes of tummy time.

Host:  There you have it. And my last question for you is what does a flattened skull affect?

Chelsea:  So, flattening of the skull can affect at what point the learn their gross motor skills. So, that means like if they have flattening of that right side of their skull, they may not do as well looking towards their left, reaching with their left, rolling over their left side because they don’t prefer that side. It can also affect at what point they start to roll. So, most babies tend to roll around four to six months old. So, sometimes that will just push that back so if they are not rolling on time, then they may not crawl on time, they may not walk on time. So, that gross motor delay is hugely impacted by a baby’s head shape. The other thing that it can affect is sometimes it can affect the face too and you can have a facial asymmetry of the forehead and an ear shift, the cheekbone and even the jaw. So, down the road, it can lead to someone having like jaw pain or trouble with eating because their jaw will get tight. It can cause a problem with how glasses fit on their face or hats because they have that facial asymmetry. So, it's very, very important to look at that and also to correct it whenever we can and whenever we notice it.

Host:  So, that’s why my glasses are always crooked. Now I know. Well this is excellent information Chelsea. You’ve been a dream. Thank you so much for being with us today to talk about plagiocephaly and what you can do for your patients and families at Highpoint Therapy. I think we learned a lot and we thank you very much.

Chelsea:  Thank you so much Deborah. It was a blast talking with you and I’m so glad to be here to help.

Host:  I hope you get some tummy time for yourself tonight.

Chelsea:  I hope so too. We’ll see if my kids want to sleep.

Host:  If you think your baby could benefit from an evaluation at Highpoint, call 812-842-2820, that’s 812-842-2820. This is the Women’s Hospital – A Place for All Your Life. For more information, please visit www.deaconess.com/highpoint. That’s www.deaconess.com/highpoint. I’m Deborah Howell. Thanks for listening. And have yourself a great day.