Selected Podcast
How to Treat Plagiocephaly
Dr. Kellogg (Pediatric Neurosurgeon) talks about how to treat plagiocephaly. Information on what plagiocephaly is, how is diagnosed, and treatment are discussed in this episode.
Featuring:
Learn more about Robert Kellogg, MD
Robert Kellogg, MD
Robert Kellogg, MD joined the Department of Neurological Surgery as an assistant professor in September of 2020 and specializes in pediatric neurosurgery. His clinical and research interests include the comprehensive management of spasticity and movement disorders and craniofacial surgery.Learn more about Robert Kellogg, MD
Transcription:
Bill Klaproth: In this podcast, we're going to discuss plagiocephaly or flat head syndrome. So exactly what is it? How is it diagnosed? And is it potentially harmful to the baby? Well, let's find out what Dr. Robert Kellogg. He is a pediatric neurosurgeon at UPMC.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Dr. Kellogg, thank you so much for your time. It's great to talk with you. So first off, can you explain to us what is plagiocephaly?
Dr. Robert Kellogg: Thanks, Bill. Plagiocephaly is a very common head shape condition that we see in infants almost every day in the pediatric neurosurgery office. It occurs when the baby lies on one side of the head or the other, or lies on the very back of the head, usually when they're sleeping at night or in the stroller or crib or something like that. And this is very common because infants sleep on their back to minimize the risk of sudden infant death syndrome or SIDS. But a consequence of that is that we see plagiocephaly fairly often. And literally, what causes it is gravity pushing down on that part of the head that the baby is lying on and it causes a flat spot.
Bill Klaproth: So, is this something that can start while the baby is in the womb? Or is this primarily something that happens after the baby is born?
Dr. Robert Kellogg: This is a really something that starts after birth and has everything to do with how the baby's positioned in the crib. So some babies will prefer to lie, for example, just on the right side of their head, someone on the left, some in the middle. Some babies will even have a condition called torticollis, which is tightening of one of the neck muscles that makes the head turn preferentially to one side or the other.
Bill Klaproth: So, is this something a parent recognizes and looks at their child's head and says, "Oh, it looks a little misshapen" or is this discovered during a normal routine office visit. How do you discover this and diagnose it?
Dr. Robert Kellogg: Well, it's both ways. A lot of times, parents will notice that their child has a flat spot on the back of their head. Other times, the pediatrician will make note of it and asks for further evaluation.
Bill Klaproth: I'm touching my head right now to feel. I'm like, "Do I have a flat spot on my head?" Okay. And it's not dangerous, is it? It's just that you just don't want your head growing in a kind of a flattened area?
Dr. Robert Kellogg: Yeah. It's not dangerous at all. The way parents noticed it, as I mentioned, is if they see a flat spot on the head where sometimes even if you look from the very top of the baby's head, you'll notice that one of the ears is pushed more forward than the other, or sometimes even the forehead will be more prominent on the one side or the other, and those can all be signs of plagiocephaly.
Bill Klaproth: Okay. Got it. So how is this treated then?
Dr. Robert Kellogg: So in most cases, we can do things such as repositioning, increasing tummy time. You can change the way the baby is positioned in the crib from night to night. So for example, if you put their feet towards one side one night, put their feet towards the other side the next night. That can encourage them to sleep on different sides of their head, things like that.
Bill Klaproth: Wow. Okay. So when you bring baby home, is there ways to prevent this then from happening?
Dr. Robert Kellogg: It's not always entirely preventable. The things that I mentioned, repositioning, tummy time are things that will minimize the chance that it happens. But sometimes, it can be difficult to prevent it from happening altogether.
Bill Klaproth: So are there other tips that a parent can do to help prevent this like holding the baby in an upright position more often, changing positions in the crib more often? I know you've given us a few already. Are there other tips for prevention?
Dr. Robert Kellogg: Increasing tummy time, changing the position in the cribs. Sometimes you can change the position of the crib in the room even to encourage the baby to sleep differently. And I should also say that plagiocephaly tends to be the worst around four months of age. That's around the time that most babies will start rolling over onto their tummies at night. Then, when they start sleeping on their tummies at night on their own, that can start to make the plagiocephaly better. So we tend to see plagiocephaly as being worst around four months of age. And if it's not dramatically better by about six months, that's when we can talk about helmet therapy to help round out the shape of the head.
Bill Klaproth: Okay. So what is helmet therapy then?
Dr. Robert Kellogg: Helmet therapy or cranial molding therapy is when a company takes measurements of your baby's head and has a custom helmet made for the baby that will, over the course of several months, help around out the back of the head and make it a more normal shape.
Bill Klaproth: So I would imagine there is obviously varying degrees of this, is that right? Some might be minor where you might just say, "We're going to leave it," to some that might be more severe. So is there different levels of severity when it comes to this, is that right?
Dr. Robert Kellogg: Certainly, there's mild plagiocephaly and there's severe plagiocephaly and everything in between. And no form of plagiocephaly will unpack the baby's growth or development or cognitive function or intelligence. So it all comes down to how the parents feel about how their baby's head shape looks. If they're unsatisfied with it and think that it's too flat, we can always treat with a helmet. If it's a little bit flat and they're okay with it, then we won't do anything. So it's really up to what the family wants to do.
Bill Klaproth: And for a new parent, when looking at the shape of their baby's head, they should be looking primarily at the back of the head. I believe you said, because we want the baby lying on their back in the cribs, so that's where they should be focusing now at the back of their head for this flattening, if you will?
Dr. Robert Kellogg: Yes, primarily the back of the head. And the best way to look is just right from the top of the head. And then sometimes you could even see the ears push forward on the same side, or even the forehead is more prominent on the side of the flat spot.
Bill Klaproth: Dr. Kellogg, thank you. This has really been informative. Anything you want to add about this condition?
Dr. Robert Kellogg: I'll just say that this is one of the most common conditions that we see. And it's something that we typically just reassure parents about. But if there is different, a more concerning head shape issue, we can evaluate for that as well. The one important thing to differentiate plagiocephaly from is a condition called craniosynostosis. This is a congenital condition that does require surgical repair, but it's completely different from plagiocephaly. So if there's ever a question about head shape, whether this head shape is okay, or whether it's just plagiocephaly or something more concerning, we're always happy to see the baby and meet with the parents and talk about what's going on.
Bill Klaproth: Yeah, that's great information and comforting for parents to know that. Dr. Kellogg, thank you so much. This has really been interesting and informative. Thank you for your time.
Dr. Robert Kellogg: Thank you, Bill.
Bill Klaproth: And once again, that's Dr. Robert Kellogg. And for more information, visit upmc.com/centralpachildrensspecialty, that's all one word, Central PA Children's Specialty. So once again, upmc.com/centralpachildrenspecialty or you can call (717) 988-9370. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth: In this podcast, we're going to discuss plagiocephaly or flat head syndrome. So exactly what is it? How is it diagnosed? And is it potentially harmful to the baby? Well, let's find out what Dr. Robert Kellogg. He is a pediatric neurosurgeon at UPMC.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Dr. Kellogg, thank you so much for your time. It's great to talk with you. So first off, can you explain to us what is plagiocephaly?
Dr. Robert Kellogg: Thanks, Bill. Plagiocephaly is a very common head shape condition that we see in infants almost every day in the pediatric neurosurgery office. It occurs when the baby lies on one side of the head or the other, or lies on the very back of the head, usually when they're sleeping at night or in the stroller or crib or something like that. And this is very common because infants sleep on their back to minimize the risk of sudden infant death syndrome or SIDS. But a consequence of that is that we see plagiocephaly fairly often. And literally, what causes it is gravity pushing down on that part of the head that the baby is lying on and it causes a flat spot.
Bill Klaproth: So, is this something that can start while the baby is in the womb? Or is this primarily something that happens after the baby is born?
Dr. Robert Kellogg: This is a really something that starts after birth and has everything to do with how the baby's positioned in the crib. So some babies will prefer to lie, for example, just on the right side of their head, someone on the left, some in the middle. Some babies will even have a condition called torticollis, which is tightening of one of the neck muscles that makes the head turn preferentially to one side or the other.
Bill Klaproth: So, is this something a parent recognizes and looks at their child's head and says, "Oh, it looks a little misshapen" or is this discovered during a normal routine office visit. How do you discover this and diagnose it?
Dr. Robert Kellogg: Well, it's both ways. A lot of times, parents will notice that their child has a flat spot on the back of their head. Other times, the pediatrician will make note of it and asks for further evaluation.
Bill Klaproth: I'm touching my head right now to feel. I'm like, "Do I have a flat spot on my head?" Okay. And it's not dangerous, is it? It's just that you just don't want your head growing in a kind of a flattened area?
Dr. Robert Kellogg: Yeah. It's not dangerous at all. The way parents noticed it, as I mentioned, is if they see a flat spot on the head where sometimes even if you look from the very top of the baby's head, you'll notice that one of the ears is pushed more forward than the other, or sometimes even the forehead will be more prominent on the one side or the other, and those can all be signs of plagiocephaly.
Bill Klaproth: Okay. Got it. So how is this treated then?
Dr. Robert Kellogg: So in most cases, we can do things such as repositioning, increasing tummy time. You can change the way the baby is positioned in the crib from night to night. So for example, if you put their feet towards one side one night, put their feet towards the other side the next night. That can encourage them to sleep on different sides of their head, things like that.
Bill Klaproth: Wow. Okay. So when you bring baby home, is there ways to prevent this then from happening?
Dr. Robert Kellogg: It's not always entirely preventable. The things that I mentioned, repositioning, tummy time are things that will minimize the chance that it happens. But sometimes, it can be difficult to prevent it from happening altogether.
Bill Klaproth: So are there other tips that a parent can do to help prevent this like holding the baby in an upright position more often, changing positions in the crib more often? I know you've given us a few already. Are there other tips for prevention?
Dr. Robert Kellogg: Increasing tummy time, changing the position in the cribs. Sometimes you can change the position of the crib in the room even to encourage the baby to sleep differently. And I should also say that plagiocephaly tends to be the worst around four months of age. That's around the time that most babies will start rolling over onto their tummies at night. Then, when they start sleeping on their tummies at night on their own, that can start to make the plagiocephaly better. So we tend to see plagiocephaly as being worst around four months of age. And if it's not dramatically better by about six months, that's when we can talk about helmet therapy to help round out the shape of the head.
Bill Klaproth: Okay. So what is helmet therapy then?
Dr. Robert Kellogg: Helmet therapy or cranial molding therapy is when a company takes measurements of your baby's head and has a custom helmet made for the baby that will, over the course of several months, help around out the back of the head and make it a more normal shape.
Bill Klaproth: So I would imagine there is obviously varying degrees of this, is that right? Some might be minor where you might just say, "We're going to leave it," to some that might be more severe. So is there different levels of severity when it comes to this, is that right?
Dr. Robert Kellogg: Certainly, there's mild plagiocephaly and there's severe plagiocephaly and everything in between. And no form of plagiocephaly will unpack the baby's growth or development or cognitive function or intelligence. So it all comes down to how the parents feel about how their baby's head shape looks. If they're unsatisfied with it and think that it's too flat, we can always treat with a helmet. If it's a little bit flat and they're okay with it, then we won't do anything. So it's really up to what the family wants to do.
Bill Klaproth: And for a new parent, when looking at the shape of their baby's head, they should be looking primarily at the back of the head. I believe you said, because we want the baby lying on their back in the cribs, so that's where they should be focusing now at the back of their head for this flattening, if you will?
Dr. Robert Kellogg: Yes, primarily the back of the head. And the best way to look is just right from the top of the head. And then sometimes you could even see the ears push forward on the same side, or even the forehead is more prominent on the side of the flat spot.
Bill Klaproth: Dr. Kellogg, thank you. This has really been informative. Anything you want to add about this condition?
Dr. Robert Kellogg: I'll just say that this is one of the most common conditions that we see. And it's something that we typically just reassure parents about. But if there is different, a more concerning head shape issue, we can evaluate for that as well. The one important thing to differentiate plagiocephaly from is a condition called craniosynostosis. This is a congenital condition that does require surgical repair, but it's completely different from plagiocephaly. So if there's ever a question about head shape, whether this head shape is okay, or whether it's just plagiocephaly or something more concerning, we're always happy to see the baby and meet with the parents and talk about what's going on.
Bill Klaproth: Yeah, that's great information and comforting for parents to know that. Dr. Kellogg, thank you so much. This has really been interesting and informative. Thank you for your time.
Dr. Robert Kellogg: Thank you, Bill.
Bill Klaproth: And once again, that's Dr. Robert Kellogg. And for more information, visit upmc.com/centralpachildrensspecialty, that's all one word, Central PA Children's Specialty. So once again, upmc.com/centralpachildrenspecialty or you can call (717) 988-9370. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.