The Neurosurgery Program’s Plagiocephaly Clinic is at the forefront of treating children with this correctable head shape condition. Because plagiocephaly has a natural progression of ongoing improvement, our interdisciplinary team use a conservative management approach. Therapeutic options that play a critical role include being repositioned often, wearing a helmet, and/or physical therapy.
Our Plagiocephaly Clinic conducts an average of more than 1,300 visits annually, providing care to more than 1,000 unique patients annually.
It is never too early for a referral to our clinic as we have Plagiocephaly Clinic each week at each Texas Children’s campus, which include head measurements and feedback on current intervention based on patient age and appropriateness for intervention.
What is Plagiocephaly/Brachycephaly?
Plagiocephaly refers to a flat spot that forms on either side or the back of a baby’s skull while brachycephaly refers to the back of the skull. Causes include:
the continuous pressure of being in one position for long periods of time
tight neck muscles
premature birth
intrauterine positioning
Plagiocephaly is often caused by torticollis, which is tight neck muscles and will often result in a turned and tilted neck and head. Torticollis usually requires physical therapy. If your baby is showing signs of torticollis, we provide same day physical therapy evaluations in our clinic during your appointment with us.
Treatment Methods
As mentioned above, plagiocephaly tends to improve over time. As babies’ muscles become stronger, they can begin to build up their neck muscles, begin to tolerate being on their stomachs and become able to reposition themselves such as rolling from stomach to back and vice versa.
Conservative Management Treatment Methods
Repositioning
Positional changes to get the baby off their flat spot is important in improving head shape by removing pressure on the flattened area of the skull. This can be accomplished in multiple ways:
Sleep: turning baby’s head to the opposite side as the flattened area while baby is on their back during nighttime and naptime
Playtime: increasing frequency of supervised playtime on baby’s tummy or on their side, positioning toys towards baby’s nonpreferred side to improve range of motion and visual gaze
Containers: limit the use of positioning devices, such as infant swings or bouncers, that place baby on their back during awake time to less than one hour per day
Feeding: alternate feeding positions so baby’s head is supported in different areas of the skull
Carrying: alternate the position in which you carry baby to encourage baby to turn their head in different directions
Wearing a Helmet (Cranial Orthosis)
Wearing a helmet is a useful, short-term solution for helping shape the baby’s head.
The brains and skulls of infants experience rapid growth in the first year of life. We can direct this growth to help shape the head by using a helmet, which acts to stabilize the part of the head that does not need to widen any further and to encourage the baby’s natural growth toward areas that need to be rounded out.
If your baby needs a helmet, they will be managed by the Hanger Clinic, which has locations in Houston, Woodlands, Katy and Beaumont. This is where the baby is fitted for and receives a helmet and also for adjustments to the helmet as your baby’s head grows. At the Hanger Clinic, all the skull correction will be obtained by one helmet only.
The length of time a child will need to wear a helmet will vary. Most babies wear a helmet for 3 months. Depending on the severity, a helmet may be worn up to 5 months. The follow-up visits at the Hanger clinic occur every 2-3 weeks.
Physical Therapy
Physical Therapy may be recommended if your baby’s head shape asymmetry is influenced by an imbalance of the neck muscles, called muscular torticollis. You may notice your baby tilting their head or turning their head in one direction as a result. PT can provide exercises to improve neck range of motion, strength and posture. Improving the flexibility and strength of baby’s muscles can promote rounding of the skull. In addition, PT can assess your baby’s developmental skills and address any delays due to muscle imbalances caused by plagiocephaly or torticollis.
