Head Shape Evaluation Program
The Children's Memorial Head Shape Evaluation Program offers a team of medical and surgical professionals who evaluate and treat infants with cranial asymmetry from any source, the most common of which is positional plagiocephaly. This team approach – consisting of a craniofacial surgeon, neurosurgeon, physical therapist, registered orthotist and clinical nurse specialist – allows families to maximize their experience in a single visit.
Using the STARscanner laser data acquisition system, our medical team is able view a three-dimensional, topographical map of an infant's head. The team can then document and compare head shape data before, during and after orthotic treatment or surgical intervention. The non-invasive procedure takes less than two seconds and provides the medical staff with specific head measurements, includingthe exact location of the asymmetry. Unlike traditional X-rays, the STARscanner uses digital technology, so there is no radiation involved.
About abnormal head shapes
When babies are born, their skull consists of six plates designed to partially overlap with one another, which allows the head to temporarily contract and fit through the birth canal. As the brain grows and expands over the first several months of life, the plates eventually slide back out and flatten. These joints (called sutures) allow for the rapid growth of the brain over the first two years, and eventually begin to close (fuse). As these sutures close and the cranial bones harden, there is less opportunity for cranial growth. During these first two years, the child's skull is soft and vulnerable, leaving them at risk for developing abnormal head shapes as adults. If left untreated, these abnormalities can lead to other medical issues later in life.
Types of plagiocephaly
Plagiocephaly is a term used to describe the “flat head” typically seen in cranial asymmetry. There are two basic types of plagiocephaly – those caused by positioning (positional plagiocephaly) and those caused by the premature fusing of cranial plates (craniosynostosis).
Positional plagiocephaly is a malformation of the skull, characterized by a flattening of the posterior skull often more prominent on one side with a compensatory bulge on the other side. There can also be an offset to the ears when viewed from the top. This asymmetry is caused when too much pressure is placed on one side of the head.
Craniosynostosis occurs when one or more of the joints between the cranial plates close prematurely. As the brain continues to grow, it forces the remainder of the skull to expand out of proportion, leading to an abnormal shape. Left untreated, craniosynostosis may also cause damage to the infant brain.
Signs of plagiocephaly
- Asymmetrical flattening of the back of the head
- One ear more forward than the other when viewed from the top of the head
- Facial asymmetry, flattening of one side of the forehead or bulging of the other side, asymmetry of the cheek bones or different eye size, and a shift in the chin point
Common causes of plagiocephaly
- Preferential sleep position, extended time in car seats
or baby play saucers, etc.
- Torticollis (also known as wryneck) is a tightening of the neck muscle that causes infants to favor sleeping on one side of the head
- Inter-uterine positioning occurring when a fetus positions itself in a constrictive area of the womb
- Multiple births
- Acid reflux, which requires the child's head to remain upright, making “tummy time” difficult
Evaluation and treatment
Early evaluation and possible intervention are important to the successful management of head and facial abnormalities. The decision to seek evaluation and possible treatment should be made as early as possible, optimally before 10 months of age.
What to expect during your visit
- You will be asked to answer questions about your child's birth history, including birth weight and method of delivery.
- You will meet with a pediatric craniofacial surgeon and other team members to determine the extent of the malformation and discuss treatment options and expectations.
- Most infants will have their cranial vault mapped with the STARscanner. This initial scan provides accurate three-dimensional data, which allows us to measure your child's progress throughout the course of treatment.
Common diagnoses and treatment
- Positional plagiocephaly: If necessary, your child will be fitted for an orthotic helmet to assist in correcting the malformation.
- Craniosynostosis: Scans are obtained in the pre-operative
and early post-operative period to document surgical changes. If an orthotic helmet is required it will be generated from this scan. No molding will be required for any orthotic helmet.