THE EFFECTIVNESS OF USING BABY PILLOW HEADPRO (PA-VM-09) FOR TREATMENT AND PREVENTING THE POSITIONAL SKULL DEFORMITY IN INFANTS

Positional skull deformity, also called flat head syndrome, may be present at birth or may develop during the first few months of life. Positional skull deformities may be caused by mechanical factors that act on the head during early infancy or in the prenatal period due to positioning in utero. Skull deformities are also common result of forceps or vacuum-assisted delivery. The head growth is the most rapid during the first 3 months, hence the deformations can develop very quickly in a newborn when bones are flexible and baby lies in supine position.

Since 1990s American paediatricians have observed an increase in the amount of children with cranial asymmetry. The main cause of this is ‘Back to Sleep’ campaign, recommending that all babies should sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). The campaign halved the number of deaths, but significantly increased the number of babies with skull deformations (during the years 2004-2008 – increase more than 400%)1!

Referring to flat head syndrome, we observe 3 main conditions:
plagiocehaly
brachycephaly
scaphocephaly (dolichocephaly)

1. PLAGIOCEFALIA

Plagiocefalia
Plagiocephaly is the most common deformation of baby’s skull. It’s diagonal cranial asymmetry where head is flat in the back on one side and facial asymmetry occurs. This is often seen in babies who spend a lot of time on their backs and do not get enough tummy time.

– head is flat on one side
– misalignment of baby’s ears
– head appears to be asymmetric
– one eye is smaller than the other
– one cheek is fuller than the other
– top of the head slopes

2. BRACHYCEPHALY

Brachycefalia
It is the shape of a skull shorter than typical. This deformation can be seen in Down syndrome. Characteristic feature:

– head is wider than it is long
– back of head is flat
– face appears small relative to the size of the head
– head is shortest in length from front to back
– head is tall
– head is wide
– forehead slopes back
– widest part of the head is just above the ears
– tips of ears protrude

3. SCAPHOCEPHALY

ScafocefaliaSo-called ‘dolichocephaly’ and head is narrow and long. This is most common in preemies who have spent their first few months of life in the neonatal intensive care units. This skull deformation i salso common in children who were wedged under ribs in prenatal life. Characteristic feature:

– head is long and narrow
– head is tall and narrow
– forehead is square

Predisposing risk factors include prenatal, perinatal and postnatal factors shown in table 1.

TABLE 1

Predisposing risk factors of positional skull deformity

Factors

Mentioned in the literature (%)

Prenatal factors

Male sex

72

Primiparous mother

45

Young parents

32

Low educational status

27

Forced abnormal intrauterine positioning

18

Perinatal factors

Obstretiv interventions (ventouse, forceps)

45

High birth weight

37

Prematurity

32

Large head circumference

23

Postnatal factors

Supine position

63

Restricted head movement, torticollis

45

Preference for one side

37

Bottle feeding without changing position

27

Little “tummy time”

27

Developmental delay, little activity

23

Źródło: Linz, C; Kunz, F; Böhm, H; Schweitzer, T, Positional Skull Deformities: Etiology, Prevention, Diagnosis, and Treatment. Etiology, prevention, diagnosis, and treatment, Dtsch Arztebl Int 2017; 114(31-32): 535-42

An important study by American Academy of Pediatrics, published in 2010 concluded that: “Deformational Plagiocephaly seems to be associated with early neurodevelopmental disadvantage, which is most evident in motor functions.2

The biggest risk is a long-term supine position in infants. Lying on the back is safe for children as reduces the risk of sudden infant death syndrome (SIDS). However, the same position causes applies of external force/pressure, which can lead to deformity of the cerebral cranium as well as of the viscerocranium. Furthermore, 64% infants with positional skull deformity suffer from neck muscle imbalance3, what is scientifically proven. This kind of condition can lead into many bad consequences such as severe poor posture.

Sutures are not connected and allow the bones to move during the birth process. Head circumference doubles in size in first 6-7 month of life. The skull is flexible and very easy to deform. Due to this fact, application of external force and pressure can lead to plagiocephaly and positional brachycephaly.

In case of head deformity, the rapid intervention is required4. The most important is changing the child’s position as from 1st day of its life5, spending as much time as possible in prone position6, and using special orthopedic baby pillow.

Unfortunately, ordinary baby pillows are not sufficient for preventing the flat head syndrome. According to researchers, only orthopedic pillow special designed for skull deformities reduces risk of flat head and muscles asymmetry7.

It is scientifically proven that using off loading, special designed pillow reduces the external forces and pressure on child’s head and limits risk of positional skull deformities such as plagiocephaly or brachycephaly8.

HEADPRO

Due to this fact, the orthopedic baby pillow HEADPROTM is recommended by pediatricians, orthopedists and physiotherapists in Poland and around the world.

HEADPRO

HEADPROHEADPRO

Sylwia Seweryn
Physical Therapist
Member of AAOP

1 Ohman A., A pilot study, a specialty designer pillow May present development al plagiocephaly by reducing pressure from the infant head, Department of Paediatrics, University of Gothenburg, 1 June 20013, Vol. 5, No.6A2, 32-37 (2013).

2 Speltz ML, Collett BR, Stott-Miller M, Starr JR, Heike C, Wolfram-Aduan AM, King D, Cunningham ML. Case-control study of neurodevelopment in deformational plagiocephaly. Pediatrics. 2010 Mar; 125(3):e537-42

3 Golden, K.A., Beals, S.P., Littlefield, T.R. and Pomatto, J.K. (1999), Sternocleidomastoid imbalance versus congenital muscular torticollis: their relationship to positional plagiocephaly, The Cleft Palate-Craniofacial Journal, 36, 256-261.

4 Hutchison, B.L., Thomson, J.M. and Mitchell, E.A. (2003), Determinants of nonsynostotic plagiocephaly: A case-constrol study. Pediatrics, 112, e316.
Persing J., James, H., Swanson J. and Kattwinkel, J. (2003), American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery.
Prevention and management of positional skull deformities in infants. Pediatrics, 112, 199-202.
Lauritzen, C. and Tarnow, P. (1999)
Asymmetric skull? Early correct diagnosis is a must! Positional skull deformities can be voided. Lakartidningen, 96, 1447-1453.

5 Van Vlimmeren, L.A., van der Graaf, Y., Boere-Boone-kamp, M.M., L’Hoir, M.P., Helders, P.J. and Engelbert, R.H.H. (2007) Risk factors for deformational plagiocephaly at birth and at seven weeks of age: A prospective cohort study. Pediatrics, 119, e408-e418.
Peitsch, W.K., Keefer, C.H., LaBrie, R.A. and mulliken, J.B. (2002)
Incidence of cranial asymmetry in healthy newborns, Pediatrics, 110, e72.
Lauritzen, C. and Tarnow, P. (1999)
Asymmetric skull? Early correct diagnosis is a must! Positional skull deformities can be voided. Lakartidningen, 96, 1447-1453.
Jonsell, R. (1999)
Infants should sleep in supine position. The risk of skull deformities can be prevented. Lakartidningen, 96, 1404-1405.

6 Hutchison, B.L., Thomson, J.M. and Mitchell, E.A. (2003), Determinants of nonsynostotic plagiocephaly: A case-constrol study. Pediatrics, 112, e316.
Peitsch, W.K., Keefer, C.H., LaBrie, R.A. and mulliken, J.B. (2002)
Incidence of cranial asymmetry in healthy newborns, Pediatrics, 110, e72.
Nield, L.S., brunner, M.D. and Kamat, D. (2007)
The infant with a misshapen head. Pediatrics, 46, 292-298.
Robertson, R. (2011)
Supine infant positioning – Yes, but there’s more to it. The Journal of Family Practice, 60, 605-608.
Miller, L.C., Johnson, A., Duggan, L. and Behm, M. (2011)
Consequences of the “back to sleep” program in infants, Journal of Pediatric Nursing, 26, 364-368.

7 Ohman A., A pilot study, a specialty designer pillow May present development al plagiocephaly by reducing pressure from the infant head, Department of Paediatrics, University of Gothenburg, 1 June 20013, Vol. 5, No.6A2, 32-37 (2013).

8 Ohman A., A pilot study, a specialty designer pillow May present development al plagiocephaly by reducing pressure from the infant head, Department of Paediatrics, University of Gothenburg, 1 June 20013, Vol. 5, No.6A2, 32-37 (2013).