Plagiocephaly is a term used to describe the flattening of one side of the skull, leading to noticeable asymmetry. While this condition is relatively common, it is crucial for primary healthcare providers, such as chiropractors, to detect and monitor it early on.

Plagiocephaly can result from external pressures or developmental factors. It is important for parents and caregivers to recognize potential signs of this condition, while healthcare practitioners play an essential role in diagnosing and monitoring infant skull shapes.

Functional: asymmetrical body and head positioning, a neck side preference where baby tends to keep the head rotated to one side, harder laying and resting surfaces, genetic factors (predisposition for softer and more malleable skull bones) and joint restriction leading to further dysfunction.  Functionality and movement patterns in infants, affect their head shape.

• • Functional causes are the most common abnormality, by far.
  • Generally develops during the first few weeks of life.

• Function affects structure.  But the good news is that commonly, functional problems can be treated!

Deformational: Conditions like early suture closure (craniosynostosis) can also lead to skull shape abnormalities. Craniosynostosis is however only considered a diagnosis with an array of other signs and symptoms that a baby can present with.  It is not a common diagnosis.

Risks associated with Plagiocephaly, when left untreated:

Abnormal head shapes are not purely cosmetic. Studies show there is a 40% risk for neurodevelopmental delays in infants with plagiocephaly, if left untreated. This manifests for example in developmental milestone delays.  There is also a risk of less commonly noticed pathologies like: jaw (temporomandibular joint) dysfunction (TMJ); links to suboptimal vision incidence (optic nerve); craniofacial tightness; feeding problems (as it can influence latching); headaches and biopsychosocial problems (Drapeau, 2016) if left untreated.

Why is chiropractic care important for my infant’s skull shape?   A chiropractor who has a special interest in working with infants and children can help navigate the functional and developmental problems involved with an abnormal head shape. 

Chiropractic care for infants and children are very important to help screen for and monitor an array of conditions associated with the abnormal head shape that have or could be developed. 

Early diagnosis is key. Due to different sutural closure times, the earlier the treatment provided for the cause of plagiocephaly, the better the outcome. This is due to malleability factors, suture closure times and movement patterns.

If diagnosis has been made after 4 months, we can usually still treat the cause of the abnormal movement pattern that led to the deformational plagiocephaly, but generally work with an orthotist, lactation consultant, neurodevelopmental physiotherapist or paediatric occupational therapist to effectively help manage and treat the cause and manifestation of plagiocephaly.

What will my chiropractor do to help my baby’s skull shape? 

Diagnosis and monitoring the progression is key.  As primary health care providers in South Africa, Chiropractors can diagnose abnormal skull shapes such as Plagiocephaly and Brachycephaly.

Chiropractors can assess the underlying causes of abnormal head shapes, including conditions like Torticollis, which is characterized by a tight muscle on one side of the neck. This muscle imbalance often causes the baby’s head to tilt, restricting movement and contributing to a flat spot on the skull. In appropriate cases, chiropractic manual treatment can help alleviate these issues by addressing the root cause.

Lifestyle advice:

In addition to manual treatment, Chiropractors provide important lifestyle recommendations to support your baby’s recovery. These may include:

• • Supervised tummy time: Essential for strengthening your baby’s neck and back muscles, encouraging proper head movement and development.
    • Starting early and gradually increasing active and supervised tummy time to 20-30 minutes a day, to establish a routine from an early age.
    • Tip: Ask your chiropractor about a technique called: ‘colic hold’ which is a handy way to hold your baby as an alternative to the cradle hold.
  • Prone play activities: Activities that encourage babies to lie on their stomachs while awake can also promote muscle development. This needs to be supervised.
    • Placing toys around your baby while engaging them in prone play, so that they can rotate their head and engage different muscle groups in all ranges. 
  • Limiting time in swings or carriers: For older infants, it’s beneficial to limit time spent in equipment that restricts head movement. This helps reduce pressure on the back of the head and encourages natural, healthy positioning.

• Encouraging head rotation.  Encourage your baby to turn their head in both directions while lying on their back, in their crib, or during tummy time. This helps prevent them from developing a preference for one side, which can exacerbate asymmetry.

• • • Tip: Place toys or objects of interest on both sides of your baby to encourage head rotation.

• Neck stretching exercises (for Torticollis cases). If your baby has a diagnosed condition like Torticollis, where a tight neck muscle causes the head to tilt to one side, specific neck stretching exercises can help improve range of motion and prevent further cranial asymmetry. Your chiropractor will help you with gentle stretches and instructions on how to perform them.

• Tip: Perform these stretches 2-3 times per day for a few seconds each time, ensuring the baby remains calm and comfortable.  Remember we never force a stretch and there are specific tips and tricks to guide baby into a stretch.

These lifestyle modifications are key components of the overall treatment plan and are important for supporting your baby’s recovery.

A collaborative approach is essential.  At the heart of successful treatment is a collaborative approach. Chiropractors empower families and caregivers by providing clear, actionable advice. It is essential that parents and child minders play an active role in implementing these recommendations consistently. The effectiveness of chiropractic treatment is greatly enhanced when combined with these lifestyle changes, making it a team effort between healthcare providers, caregivers, and the family.

A multidisciplinary approach is needed. A multidisciplinary approach ensures the best possible outcome for your baby’s skull shape and overall development.

Conclusion

Plagiocephaly, while a relatively common condition, requires careful attention and early intervention to ensure optimal developmental outcomes for infants. As a primary healthcare provider, a chiropractor plays a vital role in diagnosing and monitoring abnormal skull shapes, such as plagiocephaly, and identifying underlying factors like torticollis that may contribute to the condition. Early detection and appropriate treatment, combined with lifestyle recommendations for parents and caregivers, can help alleviate the risk of developmental delays and promote healthy cranial and motor development.