Brisbane Practice
1/26 Eva Street, Coorparoo
(07) 3324 2490
Brisbane Practice
1/148 Chatsworth Road, Coorparoo
(07) 3327 9917
Gold Coast Practice
76-122 Napper Rd, Parkwood 4214
(07) 5594 7014
positional plagiocephaly

What is positional plagiocephaly?

This is a condition that affects the skull, making the back and/or side of your baby’s head appear flattened.

The skull is made up of several ‘plates’ of bone which, when we are born, are not tightly joined together.

When we are young, they are soft enough to be moulded, and this means their shape can be altered by pressure –usually this affects the back of the head. As we grow older, these bone plates gradually fuse or stick together.

Although you may hear plagiocephaly referred to as a type of craniosynostosis (a condition where the skull plates dofuse too early), the skull plates are not fused, but moulded into a different shape – a condition that does not require the surgical treatment needed for craniosynostosis. If your doctor has any doubts about the diagnosis, your baby may need some other tests, x-rays or scans to rule out other problems.

Tight neck muscles can also influence head shape, causing your baby to preference looking to one side, spending increased time on one area of the skull causing flattening. The many muscles of the face, neck and shoulders pull on the skull in different places and directions to help influence head shape as well. This is why tummy time and symmetrical head/neck movement is important in the development of skull shape.

positional plagiocephaly

What causes positional plagiocephaly?

Positional plagiocephaly is produced by pressure from the outside on part of the skull, such as on the back of the skull in sleeping positions. It can occur while the baby is still developing in the womb but in recent years, flattening occurring after the baby is born has become much more frequent.

Since the Back to Sleep Campaign, health professionals have recommended that all babies sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS or ‘cot death’). While this does mean babies spend more time on the backs of their heads, the benefit of reducing SIDS far outweighs any dangers due to positional plagiocephaly.

If your baby lies flat on his or her back, any positional moulding is likely to be evenly spread across the back of the head. Some babies have a tendency to turn their heads in one direction more easily than the other for the first few months of life. If these babies develop positional plagiocephaly it will affect the side of the back of the head that
he or she always lies on. In severe cases, moulding of one side of the back of the head can produce unevenness at the
front, although this is usually mild. It is called anterior or frontal bossing.

 

positional plagiocephaly?

 

How common is positional plagiocephaly and whom does it affect?

Positional plagiocephaly is much more common now. Some reports estimate that positional plagiocephaly affects around half of all babies under a year old but to varying degrees. As improvement, even without treatment, is common, it is difficult to get a true estimate.

It does not seem more common in one race than another and affects males and females equally. It seems to affect pre-
mature babies more often than those born at term. This is probably because the skull plates become stronger in the last few weeks of pregnancy.

What are the symptoms of positional plagiocephaly?

There are no symptoms associated with plagiocephaly other than the flattened appearance of the back of the head – either evenly across the back or more on one side. It does not cause any pressure on your baby’s brain and development will not be affected by it in later life.

If you are worried about any aspect of your baby’s health or development and are concerned that it might be connected with his or her head shape, you should always check with a health professional that all is well.

What is the outlook for babies with positional plagiocephaly?

For children with positional plagiocephaly, the ‘natural’ shape of the head is entirely normal – it is the moulding that has
pushed it out of shape. This means that as soon as the moulding ceases, the head can start growing back towards its
normal, natural shape – when the baby is old enough not to lie in one position for a long time, and to change sleeping
position lots of times each nights, and any tendency to turn the head more easily in one direction than another has
disappeared.

This means that for mild cases, positional plagiocephaly may have corrected itself by the time a child is a year or so old.
Even more severe cases improve with time (and of course hair covers the back of the head) but even for them, some slow improvement over months and even years is to be expected, although a degree of flattening usually remains. However, it is very unusual for this to be enough to draw attention when the child is off to school.

 

What treatments are available?

There are several ways of encouraging natural improvement in head shape to be more effective:
Early recognition – the younger the child is when plagiocephaly is recognised, the better the chances of stopping
any further progression of the flattening.
‘Tummy time’ – The more awake time babies spend on their tummies, the better the chance of stopping
progression of plagiocephaly and allowing natural correction to begin. Play with your child on his or her stomach to
build strength in neck muscles for head control and time off their heads.
Sleeping position – Adjust your child’s sleeping pattern to have everything exciting (e.g. toys, mobiles, windows,
etc.) positioned in the direction that encourages your child to turn his or her head to the non-preferred side. A rolled
up towel under the mattress may help your child sleep with less pressure on the flattest part of the head. Check how
he or she is lying in the car seat or stroller too.
Physiotherapy – Physiotherapy has been shown to be very effective in early intervention for children having
difficulty turning their head to one direction. The sooner the head turns as easily one way as the other, the sooner
natural correction of head shape can begin.
Helmets – Helmets are used for treatment at times but are not always necessary. Your physiotherapist can guide
you as to whether a helmet may be helpful in treatment. Helmets help to re-distribute and change the direction of
force being put through your baby’s head, such as when spending prolonged periods of time on their back or if they
are not progressing their developmental milestones. They are most effective when worn before 6 months of age,
and must be worn 23 hours out of 24 for a period of 3-6 months.

 

At Movement Solutions we pride ourselves on our care and knowledge to our community of clients. Contact us today for support.

Developmental play

Early Developmental Play Activities

Keeping babies active and stimulated is vital during the early months of development. We’ve put together some fun ideas for you to try! Remember, if you have any concerns talk to your GP or give us a call at Movement Solutions!

Head Control

  • Tummy time is very important for developing head control and preparing for crawling and rolling. When baby is awake place them on their tummy for short periods throughout the day with toys for play.
  • Holding your baby across your lap or over your arm, on your chest, or on your bed with you sitting on the floor talking to baby can also be used as other forms of tummy time.
  • Carry your baby over your forearm, or high up on your shoulder with both their arms in front of them.
  • Turn baby onto their side. With your hands around baby’s chest, tilt slightly forward as you pick baby up. Unless your baby has a medical condition that requires you to support the head, you need not do so as long as you come up slowly.

Hand/Feet Play

  • Give your baby rattles and toys to look at and start to interact with. Early exploration will be swipes and grasps.
  • Encourage baby to bring hands to midline (line running down the middle of their body) and hands together (e.g. clapping and play with their fingers). Baby taking hands to mouth is part of this early learning process.
  • Placing baby on their side at playtime enables hands to midline without the effects of gravity.
  • Encourage your baby to reach for and hold their feet, rocking side to side in preparation for rolling.

Nappy Change Time

  • Place baby on a pillow to enable good eye contact.
  • Make sure their head is in the midline and their chin is tucked to their chest: this makes it easier for them to focus.
  • Allow baby some nappy free time to kick and move freely.
  • Tickle baby’s tummy and ‘blow raspberries’ to encourage good abdominal activation and control.
  • Bring arms or feet together and encourage baby to play with their fingers or toes.

Stimulate the Sense

  • Massage can be a very positive experience for babies and parents.
  • Encourage eye follow horizontally from 6 weeks, vertically form 8 weeks and in a circular motion from 12 weeks. That’s when they start following a mobile.
  • Music can be both stimulating and soothing.
  • Holding and playing with toys or fabrics of different textures, sounds and lights can provide different sensory experiences as well.

Positioning

  • Use many different position experiences for playtime (tummy time, side, back, supported sitting).
  • Ensure when baby is sleeping on their back that they spend equal time with head left and right to decrease the moulding/flattening effects on their head. If you notice any moulding or baby develops a preference to one side seek advice from our experts at Movement Solutions.
Tummy time

New Evidence Shows Tummy Time Importance

We speak often about the importance of tummy time – and it is something we work with in conjunction with parents.

Effective tummy time means we can decrease the amount of time infants spend in positions other than supine and decrease the incidence of plagiocephaly.

What is Positional Plagiocephaly?

During an infant’s first four to six months of life, the skull is naturally thin and flexible. It can easily change shape. When an infant at this stage, and regularly sleeps with his or her head in the same position, a flattening a part of the skull may occur.

If you would like more information or to book in with our ‘Mums and Bubs’ sessions – click here.

In addition we wanted to share the below research that gives strong insight into why working with a physiotherapist can support your baby’s health.

—–

 

Title: Use of Care Giver Education to Prevent Positional Plagiocephaly 

Clinical Question: 

P (population) Among infants less than two months of age

I (intervention) does infant positioning education given to their care givers

C (comparison) vs. no education

O (outcome) increase the amount of time the infant spends in positions other than supine and decrease the incidence of positional plagiocephaly? 

Target Population: Infants less than two months of age and premature infants with adjusted age less than two months Exclusion Criteria: Infants who have a medical condition where varying infant position may increase or cause health risk. 

Recommendation: It is recommended that care givers of infant(s) routinely receive education regarding “tummy time” and infant positioning beginning prior to two months of age to decrease the amount of time infants spend in positions other than supine and decrease the incidence of plagiocephaly.

Discussion/Summary of Evidence related to the recommendation: Prevention Education and Timing of Preventative Education Early caregiver education regarding unlimited restriction of movement, infant positioning, and safe infant environment reduces the incidence of positional plagiocephaly (PP).

Three studies demonstrated that positioning education given to caregivers decreased the amount of time infants spent in bouncers, carriers and other infant furniture and increased the amount of time spent in positions other than supine.

Education given to caregivers was effective in decreasing the incidence of PP or increasing the amount of time infants spent in positions other than supine when provided during pregnancy (Wen et al. 2011[2b]), in the immediate postpartum period.

 

RaceRunning QLD Come and Try

Ever wanted to try RaceRunning?

BLK Performance Centre are hosting a training session and come and try at the athletics track on:

When: Saturday 16th November
Time: 9-11am
Address: 1 Sports Dr, Runaway Bay QLD 4216 

RaceRunning is an innovative sport for disabled people with impaired balance. A RaceRunner is a custom-built tricycle without pedals. The first RaceRunner was constructed in Denmark in 1991.

 

 

 

 

 

 

 

 

 

 

 

 

 

RaceRunning is an accessible sport for people with cerebral palsy, and any disability that impacts mobility. RaceRunning gives people who usually mobilise in an electric wheelchair, a manual wheelchair or in a walker the ability to move by themselves and experience the feeling of running.

RaceRunning QLD invites people with a disability, their families, medical professionals, physiotherapists, exercise physiologists, sport scientists and anyone interested in checking out this sport along for the morning.

 

Please note, there will be no presentations on the day, just an opportunity to try out the bikes, kindly loaned for the day by Deejay Medical- there may be a wait to trial a bike that fits your size but we have lots of people on hand to talk to and fit you to the bike! If you already have a RaceRunner, you are welcome to bring it along and train with the group!

Do you need more information? Contact Emma Beckman on e.beckman@uq.edu.au for info about RaceRunning in QLD or contact reservations@sportssupercentre.com.au if you need info about the venue. Parking and access is well sign-posted from the entrance.

Kids who can’t sleep. What to do?

I've just got finished a Zoom Meeting for one of my gorgeous patients who lives in country New South Wales, Australia - way out west. As well as being blown away that I can share with Margot's Mum, occupational therapist, speechie, kindy teacher and support co-ordinator in real time, as we discuss her achievements and future goals for 2019, I love that the discussion about quality sleep was addressed.

So we know that children with certain genetic conditions - especially those with very pale skin - have trouble getting to sleep and staying asleep. We also know that other things make settling for sleep harder. Melatonin is a natural hormone that moderates our wake- sleep cycles and is at its highest levels at night - helping us to become drowsy and fall, plus stay, asleep. The problem is that many of the activities we currently do affect our Melatonin levels: so here are some quick tips to help max yours and your child's Melatonin levels and make for a better night's sleep!

1. Not surprisingly - avoid screen time prior to bed and if you absolutely can't, then make sure your device is set to a dim/ non blue light setting. Having your device as your alarm clock (on your bedside table) is not ideal.Try to have it in another room (for children) or out of sight for you.
2. Avoid caffeine prior to bed
3. Avoid exercise for 1-2 hours prior to bed
4. Most importantly, have your breakfast out in the sun. Squinty-eyed sun for 20 minutes in the morning helps produce Melatonin. Wearing a strappy singlet or going shirtless with no hat or sunscreen early in the morning is ideal. Of course then slap on the hat, slip on the shirt and slop on the sunscreen as the day warms.

And if you are visiting a family member in hospital or working in an office all day, make sure you get out in the sun to help produce some Melatonin. Prolonged exposure to artificial light is not a friend to good sleep. Sweet dreams people.

Race running for people with a disability has really got my heart pumping!

So many of you know that I look after children and young adults of all abilities. Most of my posts have been about babies of late and I thought it was time to introduce you to a new product and sport that is AMAZING! It’s called Race running and Dejay Medical in Australia ( no money is changing hands for that free plug!) is having come and try days in November. check their website for details. www.dejay.com.au.

What’s even greater is that Race Running debuted at the Para Athlete Championships in Europe this year. It uses a three wheeled walking/ running bike that give support via a bike seat and a chest piece for children that can walk but not run; or have reduced balance or co-ordination; or cannot walk but can use their legs to propel. it is uber friendly for participation and aerobic exercise!

Loving innovation for physical literacy!

Daisy shows us how to get crawling

Sometimes children find it really difficult to crawl. It might be because they lack body on body rotation movement patterns or upper body strength or tone. They may not be able to cross the midline easily or may have delayed protective ( positive supporting) reactions that you use to save your face when you are about to fall. Some children have balance or vestibular issues that make them fearful to put their head down. In Daisy's case, she had flat head syndrome (plagiocephaly) with reduced neck movement (torticollis) and this affected her motor skill development in her first twelve months.

Have a look at these lovely videos of us encouraging Daisy to link sitting to tummy and vice versa; high kneel to develop better control around her low back and tummy; practicing her arm parachute reactions; achieving all fours and beginning to crawl, once her neck range is all okay.

Here’s a quirky way to encourage tummy time – see our resident model Grace who is now six months enjoy some paddle boarding in Brisbane in Spring!

Always use your imagination to encourage tummy time. It might be on a paddle board; it could be in a hammock; or on mum’s or dad’s tummy or back.

In fact the big push now is that even if your child doesn’t like their tummy, avoid wake time on their back to prevent flat head syndrome or torticollis (preferential head turn). Sitting up supported time will help develop neck strength and assist with minimising head moulding.

Awesome tummy time!

So your baby doesn’t like tummy time….

The SIDS campaign has been incredibly successful with its “back to sleep” message. I totally support this initiative. What hasn’t been so effective has been promoting the other side of the message which is “tummy time or vertical to play”.

The past fifteen years we have seen an explosion in the management of flat head syndrome or plagiocephaly, with baby helmets rivalling bottled water as a growth industry! Absolutely, sleep our littlies on their backs but introduce awake tummy time as soon as you can. Your baby doesn’t have to go on the floor: they can be on your chest, across your lap or on the change table. You can roll them onto their tummy to dry their back after a bath. Tummy time is crucial for development of strong back and neck muscles and heads that don’t have a flat spot because your baby prefers to turn their head one way.

Our resident baby model Gracie (first offspring of physiotherapists Christy and Mitch) demonstrates some positions of choice with a skin to skin ( kangaroo) cuddle with Dad and using a bed nest to help with head control and elbow position (see how elbows are under Grace’s shoulders).

Sometimes babies can have a shortened neck muscle which is located at the front and side of their neck. It’s called the sternocleidomastoid muscle and the condition is commonly called torticollis. It can be associated with flat head syndrome because a baby has difficulties turning their head due to the muscle on one side of the neck being tight and the muscle on the opposite side being weaker.  The goal is to get your baby to sleep with their head turned to their least favourite side – not so easy when they are sleeping 18 hours per day (or not sleeping at all). In my next post I’ll give you some sneaky tricks to help with this and some practical hints.

But to finish up tonight, here’s a tip: babies start consistently eye following horizontally at about six weeks of age. This is a good way to start them turning their heads. They can focus on someone (usually Mum or Dad – the loves of their life and ultimate protectors!) from a hand spans’ distance. Put your thumb on your nose and spread your hand and your little finger: this is where bub will need to be to focus on you. Then get them to start to eye follow from side to side, gradually increasing the range until they are experts!

How do you build your child’s core strength?

 

Co-ordinated Kids

Sometimes children need a little extra help when it comes to learning about their balance and coordination. Our physiotherapy partners Movement Solutions believe all children should have the opportunity to learn and practice these skills to be the best they can be and actively participate with siblings and friends at home, daycare and kindy.

These classes are especially popular for children preparing to start school. They are run by our physiotherapists in the gym space and are fun and encouraging.

Classes are circuit style with a number of different stations each with a different challenging but fun task to try.  While the classes are run by a physiotherapist the children do require parental supervision and assistance at all times. The classes are limited to a maximum of four children. These 45 minute sessions suit their concentration span and energy levels.

These sessions are ideal for:

  • Low muscle tone

  • Premature infants

  • Developmental delay

  • Motor dyspraxia

  • Cerebral Palsy GMFCS I and II

  • Genetic conditions

Programs focus on a number of goals:

  • Co-ordination and balance

  • Gross  motor skills

  • Walking and running style

  • Hand eye co-ordination

  • Turn taking

  • Socialising and group play

When does Co-ordinated Kids run?

  • Monday and Thursday Mornings at Coorparoo
  • Monday mornings and Thursday afternoons at Parkwood
  • Friday Mornings at Sherwood

Costs:   $40 per session paid at the start of the term as a package. To secure your placement, please ensure that payment is arranged prior to the first class. Please talk to our reception staff about payment methods     * Private health fund rebates vary according to your fund and level of insurance   ** Better start or NDIS funding eligible.

Please call Movement Solutions’ receptionists at Coorparoo on (07) 3324 2490 or Parkwood on (07) 55947014.  No refunds or credits can be given for missed classes.