Frequently asked questions about positional plagiocephaly

Here are some of the more frequently asked questions about positional plagiocephaly in general.


I thought positional plagiocephaly was a rare condition, but my friend’s baby has it too. How common is it?
Great Ormond Street Hospital says that some reports estimate that as many as 1 in 2 (50%) babies under a year old have some degree of deformity.

Even if GOSH is over-estimating the figures, there's a study by Hutchison (http://pediatrics.aappublications.org/cgi/content/abstract/114/4/970) that says that 1 in 15 (6.8%) of the babies studied had plagiocephaly at 12 months.

Members on here have mentioned their own experiences: for example, 3 out of 30 (10%) babies at one playgroup had positional plagiocephaly; and 2 babies out of a group of 8 (25%) in a postnatal class had it.

Unfortunately, a lot of newspapers when they write stories about this refer to it as rare - solely because they have not heard of it before.

Why so some babies get plagiocephaly and others don't?
There are some factual reasons:

• if a baby is premature it has a softer skull, which is more prone to being moulded;
• it can be caused or started off in the womb, usually due to a lack of space: being a twin or triplet means a baby is more squashed in the womb and the lower baby's head is usually engaged for a lot longer than other babies; lack of amniotic fluid in the womb means a baby has less cushioning against the mother's bones; longer babies get squashed up more; a small mother will cause the baby to be more squashed;
• torticollis - this is one of the biggest causes of plagiocephaly and torticollis can often be caused by trauma at birth (a long third-stage of labour, forceps delivery, etc.) or the muscle can shorten as a result of the baby's position while in the womb;
• positioning - another of the biggest causes - babies who are on their backs all day are more at risk - they spend lots of time in baby swings, bouncy chairs, car seats, buggies, etc.

And there are reasons that are guesswork or unproven theories:

• lazy babies - boys are apparently more lazy, and boys develop positional plagiocephaly more often;
• heavy babies - the same goes for the lazy reason.

So the outlook is not good for a tall, first born, triplet boy, with torticollis, who was born early to a small mother and who spends all day resting on the back of his head!!


Why is positional plagiocephaly not treated on the NHS as standard?
Almost certainly it’s a matter of cost. If, as GOSH says, 50% of babies have a deformity, then as many as 320,000 babies a year would have positional plagiocephaly. If say 25% of those were severe enough for helmet treatment, that would equate to 80,000 babies a year. With the least expensive helmet costing £1,700.00, that would be £136m a year for the helmets alone, not to mention all the consultant time, paperwork and promotional material needed.


Why do more babies seem to have right-sided plagiocephaly?
Right-sided plagiocephaly is more common due to the fact that the most usual position for a baby before delivery is LOA (left occipital anterior). That is, the back of the baby's head is facing to the left of the mother, and slightly to the front. The baby’s face is pointing back towards the right buttock, and hence the back right hand side of its head is pushed up against the front of the pelvis.

Also, postnatally, around 80% of babies turn to the right anyway.


My baby only looks one way. I’ve seen some exercises to counter this on a torticollis site. Is it safe to follow them?
Torticollis can be caused by up to 80 different pathologies. Most are benign and muscular torticollis is one of these. Others though are potentially life threatening if the bones in the neck are damaged or are not forming properly. Manipulation in these cases could cause death or permanent disability. It is best to seek advice from a qualified physiotherapist or from your orthotist before undertaking any exercises for torticollis management.


Can I measure my baby myself to get an idea of the severity of his condition?
Here's a guide to doing measurements yourself:

• plagiocephaly - you really need some calipers, or something that can be used in the same way. You need to measure the head from above the outside corner of each eye, diagonally across to the opposite side of the head. Technically you are supposed to do it at 30 degrees, but if you do it at the same diagonal angle each time, you at least will be consistent in your measurements. Subtract the smaller length from the larger, in millimetres, and this will give you the asymmetry. Over 6mm is mild, 6-12mm is moderate and over 12mm is severe.
• brachycephaly - using calipers again, measure the width of the head at its widest point, and measure the length of the head from front to back. Take the width and divide it by the length, then multiply by 100. This will give you a figure that will most likely be in the 70s, 80, 90s or 100s. A non-brachy head will be 80.9 or less. Over 81% is brachycephalic, but many normal looking babies are technically brachycephalic. Brachycephaly is really not as noticeable until the figure reaches more like the 90s and 100s.
• dolichocephaly - again, measure the width and the length and do the same calculation. A non-dolichocephalic head is 76% or more. Under 76% is dolichocephaly, which is also known - although very rarely - as bathrocephaly.
  

How many babies are there in helmets in the UK?
No precise figures are published. An estimate for 2005, made by Plagio UK from talking to the various suppliers, was 1,000. It is probably higher than that now due to increased awareness and publicity about positional plagiocephaly.



How do I pronounce the names of the conditions?
It depends where you live. In the UK, the correct pronunciations are:

- play-gee-oh-keff-a-lee
- bray-kee-keff-a-lee
- doe-lee-koh-keff-a-lee

But if you are in America, it's "seff" instead of "keff" and "brack-ee" rather than "bray-kee".