Bound By Grace

 I wanted to make a special post about plagiocephaly because it’s becoming more common (thanks to the “Back to Sleep” campaign), is often easy to correct and maybe even prevent, yet still not widely recognized/appreciated by family physicians. It’s also something that was becoming noticeable with Andrew, and, knowing what I know now, was something my last baby showed signs of.

The article I quote below is just one I happened across that I think does a reasonable job of drawing attention to the condition. It also focuses on the idea of plagio being a secondary condition of muscular torticollis. Muscular torticollis is a tightening of neck muscles in a baby’s neck causing limited movement of their head, often occurring on one side, and as such, the baby always lays on a particular side of his head and that causes the plagio. While this is certainly something worth being aware of, this is not the focus of my post. It does not apply to my circumstances.

“When infants sleep in one position, there is consistent pressure on their soft and forming skull, which can result in deformation of the head,” explained Dr. Graham, who estimates the clinic handles 250 to 300 visits a year for this condition. “Unfortunately, many care providers are unaware of the symptoms and inappropriately reassure parents that the child will grow out of it. Left untreated, torticollis and plagiocephaly can result in permanent distortion of the head as well as persistent facial asymmetry.”

The result is often needless worry, he added. “It’s really a very simple problem that needs to be more clearly recognized by the medical community and public.” Muscular torticollis is usually caused by the limited room in the uterus for the baby during late gestation, and it is even more common with multiple gestation (twins or triplets). Torticollis can be difficult to detect at birth or in young infancy because the neck is relatively short. One noticeable symptom is a persistent head turn, and parents frequently report a preferred resting position with sleep. After age six months, the neck begins to lengthen, and tilting of the head toward the tight side may become more evident, suggesting the need for neck physical therapy.

Source: SIDS prevention tactic leads to epidemic of ‘misshapen head’ in infants

I am not advocating this particular article as THE article of reference and information on the subject, but it’s a reasonable starting point. It’s up to you to take the information and do further research.

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There were times with my other babies that my mil would encourage me to rub and massage my babies’ head whenever she noticed lumps or lopsidedness. I used to think it was kind of funny and pretty pointless. But now I know there was something factual behind the theory (although I suspect it would take an awful lot of constant massaging to effect any change).

There is definitely something to it. After all, my baby is currently wearing a helmet almost around the clock in an effort to reshape his head. And the methodology has been proven to work. Of course, the medical reason for his helmet is to encourage his temples to round out, while slightly holding back the back of his head (and to some degree the center of his forehead) to give the temples a chance to catch up.  But as I mentioned in the beginning, he also has plagio, as mild as it may be considered by the specialists. So the helmet also serves to help correct this. As a matter of fact, the orthotists responsible for the maintenance of Andrew’s helmet therapy more commonly treat babies with positional head-shape conditions than babies using helmet therapy following surgery for cranio (given the rarity of cranio and the even more rare endoscopic procedure/helmet therapy method of dealing with it). When I pointed out his plagio to them, they nearly laughed - they are used to seeing much more severe cases. But, none-the-less, it was stilll very noticeable to me, and actually more bothersome to me than the shape of his head as a result of the cranio. I had long become attached to the cute little slant of his eyes, and, though he has no “corners” on his forehead, the angling of his temples really aren’t severe. We chose the corrective method that we did more to make allowance for frontal brain and forehead growth and not so much for “normal” head shape. His plagio by itself, certainly as it was before we started helmet therapy, would have never been considered for helmet therapy by the specialists, and surely not by us.

Here are the signs of plagio, according to the article linked:

• the back of the head is flattened on the same side that the forehead is more prominent
• the ear on the side of the occipital flattening (at the back of head) can be larger and advanced forward, compared to the other ear
• the jaw can be asymmetric, with an upward slant on the same side as the shortened muscle
• facial asymmetry, with one cheek appearing more full and one side of the forehead appearing more prominent than on the other side

Yes, Andrew’s physical characteristics were quite mild compared to how bad some babies can get before a parent is often finally able to get others to pay attention & find somebody who can tell them what is going on and by then, helmet therapy is probably your best bet for getting something close to reasonable head roundness and facial symmetry. By then, the baby is older (maybe 6 months) and not spending so much time on the back of his head, so things may still improve without a helmet, but not as much as with one. But we are talking about physical attributes that are so obvious that everyone can’t help but take notice, and that a physician would not be able to ignore. But, again, this is not so much my reason for writing, although it’s worth keeping in mind for the sake of prevention.

I suspect my readers (all 5 of them) are more independent thinkers. You do what’s best for your babies, while keeping in mind risks and taking reasonable and responsible precautions. You hold, cuddle, carry and nurse your babies (as you are able) in ways that provide for their emotional/spiritual needs as well as their physical, according to what is most appropriate within your family dynamics. No two families or babies are identical, things will work differently under different circumstances. You also learn and grow with each new baby and methods and priorities sometimes change or transform. Sometimes something that works becomes a habit with future babies. But whatever the case, you figure your babies are not very likely to be laying in one spot on one side of his head (or the back of his head) so much that this “plagio thing” would be much of a concern.

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As I mentioned at the beginning, looking back I am certain that my last baby, #6 (4th boy who just turned 4), had a mild case of plagio. I noticed some signs of it at the time, but I had a difficult time getting anyone else to notice it. My husband and my mil said they noticed it when I took pains to point it out to them, but they showed little interest or concern. I felt pretty helpless and then somewhat silly that it didn’t seem to bother anyone else. In the end, I resolved myself to just kind of hoping it would go away, or at least never become noticeable to others. After all, it really was just a slight physical anomaly. The only thing I noticed was a slight “bossing” of one side of his forehead; the right side of his forehead was just slightly more rounded or prominent than the left side. It is slightly more prominent. If I look carefully, I can tell it’s still a little “off.”

O.K. It really is no biggy. And we are not the kind of people to be obsessed about perfect physical features. Nobody’s perfect. And there are other, much more important things to focus on. But now that I know about plagio, the signs and what causes it, I know exactly what I did to cause the bossing of my four-year-old’s forehead. It’s the same thing I started out doing with Andrew (and still sometimes do), before I learned about plagio & began noticing the same bossing on the right side of his forehead along with some other asymmetry in his face. I even noticed that his right ear was more forward than his left before I even knew to look for it. (Given his circumstances from birth, I have been much more attentive to his head shape, and, admittedly, the “bossing” made his right temple and brow look a little less “trigonocephalic” than his left). 

What caused it was my creation of a designated “baby spot” on my bed.  To avoid having baby between dh and I, I created a little “safe spot” on the other side of me and learned to mostly nurse #6 from that direction at night. Anyway, it induced the habit for him to lay with his face toward me. This same tendency was encouraged in Andrew.

It would have been nice to have been aware of this tendency and possibility back when my 4-year-old was a baby, especially given how easy it would have been to avert from birth; even to reverse from a few months old. Without noticing any flattening on the back of the head of the side your baby “always seems” to lay on, and without knowing how this affects the forehead and face, who would guess that a slightly more rounded half of forehead and a “sort of crooked-looking” smile could be caused simply by the habitual sleeping position of a baby?

I just thought it’s something you “baby-making machines” might want to keep in mind. It will often likely never be an issue with most of us baby-carriers. But if you think you finally got the ”perfect” nursing/napping/sleeping technique that works for you after so many babies, it may be worth re-evaluating for your current or next baby - at least throwing in a change now and then - if it involves facing one direction all the time.

Again, it’ll likely be no real biggy, but armed with the knowledge of this particular cause-and-effect, you can at least know what may be causing that slightly “off-balance” look in your baby’s face.

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