Many factors can be associated with cranial asymmetries. Some occur before birth because of limited space in the uterus. These can occur with multiple births, first born, breech births and male babies. Some asymmetries also occur during or after births. They can happen after long labors or from poor muscle tone, spine abnormalities, neck muscle tightness and positioning. Long periods of time in one position can also misshape an infant's head.
What is plagiocephaly?
Positional plagiocephaly is a disorder in which the back or one side of an infant's head is flattened, often with little hair growing in that area. It's most often the result of babies spending a lot of time lying on their backs or often being in a position where the head is resting against a flat surface (such as in cribs, strollers, swings and playpens). Learn more about plagiocephaly.
What is brachycephaly?
Brachycephaly is symmetrical flattening on the back of the head. This causes the head to look very wide above the ears and short from front to back. From the side, the back of the head looks taller than the front.
What is brachycephaly with asymmetry?
This is a head shape that has both brachycephaly and plagiocephaly.
What is scaphocephaly?
Scaphocephaly is a head that is shaped long front to back and very narrow from side to side.
What is torticollis?
Torticollis is a tightening of the neck muscles on one side of the neck. It causes the head to tip toward the affected side and rotate toward the opposite side. This preferred positioning of the neck can lead to an asymmetry of the head. If the child has torticollis, physical therapy may be recommended for further monitoring and instruction. Learn more about torticollis.
What is craniosynostosis?
Craniosynostosis is a premature union of the bones of the skull. If this happens before the child reaches full brain growth, it can cause an abnormal head shape. Doctors use physical examination and sometimes CT scans to tell the difference between craniosynostosis and plagiocephaly. If a child has craniosynostosis, Boston Bands are not used until after surgery.
The Boston Band uses a 3-D scan of the infant's head to ensure a custom fit. The band is made from a unique closed cell foam layering technique covered by a lightweight plastic shell. This allows the orthotist to remove layers when necessary as the child grows. The design of the band insures contact with the bulging areas of the child's head, leaving the flat areas free to grow. This enables the child to lie in any position he/she wants.
The Boston Band is typically recommended for children who are 3-18 months old and have any type of cranial asymmetry that has failed to improve with conservative measures, such as repositioning and/or using the Plagio Cradle.
How long the child may need to wear the Boston Band depends on how flat the head is and the amount of growth remaining. Children typically wear the Boston Band 23 hours a day for four months. Based on the child's age and head shape, the orthotist will outline a treatment plan specific to the child.
A general course of treatment for the Boston Band involves:
Custom helmet designs
You and your child can select from a wide range of artwork to create your very own theme for a cranial helmet. Many of these designs are patterns that can cover the entire helmet, while some are made to be placed on specific areas.
The Plagio Cradle was developed by Gary Rogers, M.D. and James Miller, CPO, at the Children's Hospital of Boston. This product is for preventing or treating early signs of plagiocephaly, not brachycephaly or scaphocephaly.
The Plagio Cradle is typically recommended for children who are 0-3 months old and must be discontinued immediately when the child exhibits signs of being able to roll over.
A general course of treatment for the Plagio Cradle involves:
The American Academy of Pediatrics recommends placing sleeping infants on their backs to prevent the risk of sudden infant death syndrome (SIDS).
Because an infant's skull is flexible, he/she runs the risk of flattening his/her skull when against any surface. Doctors recommend alternating positions of the infant to evenly distribute the pressure of gravity on the growing skull. When parents observe flattening on the head, they should encourage a position where the flat spot is not touching. Supervised tummy time during the day is also important. A child should spend half of his/her waking time on his/her stomach.
Repositioning is considered conservative treatment of cranial asymmetry for a child less than 6 months old. If repositioning does not improve the shape of the child's head after two months, a doctor may recommend a Boston Band.
Parents should plan on an hour for their first appointment. During this appointment, the orthotist will give the parent information about repositioning techniques, plagiocephaly, Plagio Cradle and Boston Band protocols. A general history will be taken, as well as detailed measurements and a 3-D scan.
Cost and benefits of using our cranial helmets:
To make a referral to one of our Cook Children's Home Health locations, call 800-747-8242. A representative will assist you.
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