xamining your child's head, without having to order lab tests or X-rays. The doctor will also note whether regular repositioning of your child's head during sleep successfully reshapes the growing skull over time (craniosynostosis, on the other hand, typically will worsen).
If there's still some doubt, X-rays or a CT scan of the head will show the doctor if the skull bones are normally separated or if they fused together too soon. If the bones aren't fused, the doctor will probably rule out craniosynostosis and confirm that the child has positional plagiocephaly.
Treatment for positional plagiocephaly caused by sleeping position is usually easy and painless, entailing simple repositioning of babies during sleep to encourage them to alternate their head position while sleeping on their backs.
Even though they'll probably move around throughout the night, alternating sides is still beneficial. Wedge pillows are available that keep babies lying on one side or the other, but be sure to check with your doctor before using one to ensure that it's appropriate and safe for your baby. The AAP does not recommend routinely using any devices that might restrict the movement of an infant's head.
In addition, you may want to consider moving your baby's crib to a different area of the room. If there's something in the room (a window or toy, for example) that's catching your baby's attention and causing him or her to hold the head in a similar position day after day, moving the crib will coax your child to look at it from another position.
Always be sure your baby gets plenty of supervised time on the stomach while awake during the day. Not only does "tummy time" promote normal shaping of the back the head, it also helps in other ways. Looking around from a new perspective encourages your baby's learning and discovery of the world. Plus, it helps babies learn to push up on their arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen the neck muscles.
If torticollis is the cause of your baby's flattened head, a course of physical therapy and a home exercise program will usually do the trick. A physical therapist can teach you exercises to do with your baby involving stretching techniques that are gradual and progressive. Most moves will consist of stretching your child's neck to the side opposite the tilt. Eventually, the neck muscles will be elongated and the neck will straighten itself out. Although they're very simple, the exercises must be performed correctly.
For kids with severe positional plagiocephaly, doctors may prescribe a custom-molded helmet or head band. These work best if started between the ages of 4 and 6 months, when a child grows the fastest, and are usually less helpful after 10 months of age. They work by applying gentle but constant pressure on a baby's growing skull in an effort to redirect the growth.
But never purchase or use any devices like these without having your child evaluated by a doctor. Only a small percentage of babies wear helmets. The decision to use helmet therapy is made on a case-by-case basis (for example, if the condition is so severe that a baby's face is becoming misshapen or the parents are very upset). Although helmets might not improve the outcome in all children, some kids with severe torticollis can benefit from their use.
The outlook for babies with positional plagiocephaly is excellent. As babies grow, they begin to reposition themselves naturally during sleep much more often than they did as newborns, which allows their heads to be in different positions throughout the night. After babies are able to roll over, the AAP still recommends that parents put them to sleep on their backs, but then allow them to move into the position that most suits them without repositioning them onto their backs.
Most skull-flattening deformities are self-corrected by the time the child is 1 year old. A persistent, severe, or cosmetically obvious deformity can be corrected with reconstructive surgery between 12 and 18 months of age, but very few cases require t