Plagiocephally Flashcards
Plagiocephaly
can occur as a result of abnormal forces on the skull before or after birth
before birth:
- when baby descends into the pelvis
- if mom has abnormally shaped uterus
- if the fetus is in an odd position
- if one of twins/triplets
BABY’S HEAD SHOULD GO BACK TO A NORMAL SHAPE 6 WEEKS AFTER BIRTH
benign positional molding posterior plagiocephaly occipital plagiocephaly plagiocephaly without syntosis deformational plagiocephaly
Neonatal flattening of the occiput
present at birth -in utero -multiple births -assisted delivery: forceps delivery resolves provided there is proper postnatal positioning
Deformational Plagiocephaly
1) pressure on the occiput of the growing skull causes it to flatten
2) more common on the RIGHT than the left
(lady said if torticollis on the left sternocleidomastoid will cause baby to lie on the right and pushes the skull forward on the right)
3) more common in MALES
4) craniofacial assymetries may occur
**different than craniosyntosis
[online: sutures close too early, causing problems with normal brain and skull growth. Premature closure of the sutures may also cause the pressure inside of the head to increase and the skull or facial bones to change from a normal, symmetrical appearance.]
Risk Factors for Plagiocephaly
1) multiple births
2) prematurity:
higher risk since the cranial bones become stronger and harder in the last 10 weeks of pregnancy,
NICU on respirator, their heads are maintained in a fixed position increasing risk
3) torticollis can cause plagiocephally
4) positioning: the part of the skull that is dependent tends to flatten out
5) developmental delay -is it the cause or effect???
Craniofacial Assymetries
1) on flat side:
- ear more forward
- cheek and forehead more prominent and forward
2) eyes not level
(lady said if torticollis on the left sternocleidomastoid will cause baby to lie on the right and pushes the skull forward on the right)
Characteristic Features Plagiocephally
1) parallelogram shaped head
2) ear asymmetry: ear on flattened side is forward
3) pronounced cheek on flat side
4) top of head may be tilted
5) forehead may be angled with one side bulging forward
6) back of one side of head is flattened
7) inferior displacement of the brow on the contralateral side
Assess in plagiocephaly
view the infants head from the top to see the parallelogram shape and flattened occiput and bulging ipsilateral forehead
assess for torticollis (lateral flexion to the affected side and rotation to the opposite side)
assess for facial assymetries
Intervention plagiocephaly
1) parent education regarding prevention:
- tummy time
- limit time in infant seats/swing
- reposition head when going to sleep (turning head to different directions)
2) turn head so that the rounded side is down when going to sleep, repositioning not successful with CMT (congenital muscular torticolis)
3) change baby orientation in the crib: place baby head near the foot of the crib one day and at the head of the crib the other day
4) hold baby with alternate hands at each feeding
5) DOC: Band Dynamic Orthotic Cranioplasty
When intervention should be:
first 3 months of life are most effective for handling and repositioning
***condition does NOT self correct without intervention
DOC
purpose
Band Dynamic Orthotic Cranioplasty
use after repositioning trial
purpose: applies pressure to anterior and posterior portions of the cranium where growth is not wanted and allows growth in flattened areas
DOC
what does infant have to have
Band Dynamic Orthotic Cranioplasty
infant should have adequate head control in order to wear a helmet
DOC
what is changed to accomidate changes in skull
Band Dynamic Orthotic Cranioplasty
the inner foam lining of the doc band is changed on a biweekly basis based on changes that occur to the skull
Age can baby wear DOC? what age prohibited?
Band Dynamic Orthotic Cranioplasty
AGE 3-18 MONTHS
FDA has approved the use of DOC in infants and toddlers
FDA prohibits dispensing of helmets for cranial remodeling after 18 months of age
How many hours wear DOC? Months?
Band Dynamic Orthotic Cranioplasty
23 Hours/day
1 hour to clean skin and do the ROM exercises for the neck
*length of tx about 3-4 months but could be longer depending on severity
Plagiocephaly: AAP report notes that the best response to helmets occurs what age ???
range 4-12 months
- -malleability of the infants skull
- -rapid growth during this period
researchers recommend orthotic treatment be initiated by 6 months of age
children older than 12 months: could still benefit but tx takes longer and outcome could be less successful than when tx is initiated earlier
Consequences of not correcting Plagiocephaly
- psychological development: self esteem
- TMJ secondary to lack of mandibular alignment
