Positional Head Deformity

What is Positional Head Deformity?

The skull is made of several hard pieces of bone that are joined together with loose connections called "sutures." These loose connections allow the baby's brain to grow but still be protected by the skull bones. The skull of the baby is soft and can change shape because of outside forces. For instance, the position in the uterus may affect a baby's head shape, and the baby's position in the crib can also cause flattening of the skull if the pressure isn't frequently relieved. This results in a condition referred to as "positional head deformity" or PHD.

PHD does not effect brain development or brain function. The major reason for treating PHD is to correct an abnormal head shape.

What are the physical changes associated with PHD?

• Flatness of the back or either side of the infant's head (occipitoparietal flattening)
• Bulging or bossing of the back of the head on the opposite side (occipital bossing)
• Frontal bossing (a bulging forehead on the same side of the occipital flatness)
• Ear appears thrusted forward on the affected side
• Torticollis (stiff neck)

What are the treatment options?

Your doctor will help you to decide which option is best for your baby. It is important to follow the progress of your baby's treatment and you should continue to see your doctor every two to three months.

List of Physicians Who Treat Positional Head Deformity

For details about education, experience, and specialty in this clinical area, please visit these physician profile pages:

• Steven Buchman, M.D.
• Steven Kasten, M.D.

Positioning

The most important treatment of PHD is proper positioning. The baby should be put down to sleep on his unaffected side (the non-flat side) as much as possible. Changing your baby's head position should not be isolated only to sleep time, but also also encouraged in the car seat, stroller as well as nursing and feeding time. This will help to take the pressure off the flattened area. If the baby has torticollis, he should be positioned so that he will turn his head to the nonfavored side. Position his crib so that he must turn his head to the nonfavored side to see light from a window and to see his mobile. If the torticollis is particularly severe, physical therapy may be prescribed.

Helmet Therapy

Usually, with proper positioning, the baby's head deformity will improve. If pressure is allowed to continue on the back of the baby's head, it could cause a permanent deformity of the head, and the face, too. In moderate to severe cases, or in cases which have failed to improve with positioning, helmet therapy may be an option.

A custom made helmet is constructed by first making a plaster mold of the baby's head. This mold is then used to create a lightweight plastic helmet that is padded and fitted to treat the baby's specific abnormal head shape. Helmet therapy is a safe and effective way to encourage the baby's head to expand into a more normal and symmetric shape. Each helmet is designed to fit snugly against the prominent aspects of the skull and to be looser fitting where the head is flat. As the brain grows, the head is molded to fit the helmet and thus acquires a more normal shape.

For detailed information about helmet therapy, you may visit the University of Michigan's Orthotics and Prosthetics Center website.

What can I do if I think my baby has PHD?

Your pediatrician should be able to diagnose PHD during your baby's regular check-ups. However, it is important that your doctor consider an alternative diagnosis that causes a similar abnormal head shape, called craniosynostosis. This condition, unlike PHD, can cause intracranial pressure because the sutures of the bones surrounding the brain close too early. Craniosynostosis usually requires surgical intervention.