Positional head shape abnormalities in NICU babies
- CPBF
- 3 days ago
- 4 min read
By Dr. Namrata Todurkar
One of the most important goals of NICU care is not only survival, but intact survival of babies who can reach their full growth potential in all aspects of life. This can mean various things to families and treating team. While there is a lot of emphasis on medical complexities, things like positional head shape abnormalities/differences can be missed until the time of discharge. It is also sometimes called as deformational plagiocephaly- when a baby develops a lasting flat spot on one side of the head or the back of the head. A change in head shape can be very concerning to the family, but the good news is: it is treatable. Many cases will improve with conservative treatment alone, provided attention is directed early to the problem. This blog will discuss the causes, symptoms, treatment and prevention of positional head shape.
How common are positional head shape abnormalities?
Occurs in upto 50% of all neonates, and affects upto 75% of NICU graduates. The prevalence increases with decreasing gestational age. It is most commonly mild in nature.
Causes:
The skull of neonates is made of both bones and cartilage. Unlike adult skull, the neonatal skull is not yet fully calcified. More so, in babies born preterm. Therefore it is mouldable and susceptible to change shape depending on the site of pressure application. It takes a lot of energy for babies to turn their heads. So those with severe flattening on one side tend to stay on that side, and their necks become stiff from lack of use. A combination of factors, many of which are interlinked, can culminate in this condition. Namely:
1. Being very sick- due to restricted positioning
2. Low birth weight- set up for poorly mineralised bones
3. Poor bone health/ Metabolic bone disease
4. Gastro-esophageal reflux- due to preferencial positioning
5. Mechanical ventilation- due to restricted positioning
6. Neurological illness- low muscular strength to move
7. High turn over NICU- less time with staff to optimally position every baby
8. Less skin to skin time opportunities- baby always lying down
9. Post surgical positioning- due to restricted movements
10. Genetic syndromes- such as Apert and Crouzon syndrome
11. Familial- abnormal head shape runs in families
12. Torticollis/ tightness of neck muscle- inability to move head both sides equally
13. Restricted uterine environment from multiple births or uterine abnormalities- born with abnormal head shape
14. Birth trauma/ instrumental delivery- skull fractures or neck muscle trauma
Symptoms:
Usually noticed by parents as:
• The back/ one side of the baby's head is flatter on one side.
• Elongated shape of head from front to back
• The baby usually has less hair on that part of the head.
• When looking down at the baby's head, the ear on the flattened side may look pushed forward.
• In severe cases, the forehead might bulge on the side opposite from the flattening, and may look uneven.
• If torticollis is the cause, the neck, jaw, and face also might be uneven.
Treatment:
Act early — before the skull bones fuse (about 12 months).
Many cases improve just with:
• Changing baby’s position often.
• Physical therapy if the neck is stiff.
• At-home stretches.
Sometimes, doctors recommend helmets to gently shape the baby’s head.
The PLAY Bundle involves the Positioning and Physiotherapist/Occupational therapist involvement, Learning, Assistive Devices, and You (PLAY) Bundle. On average, though, babies who get helmets and those who don't have the same results after a couple years.
Prevention:
Always put babies on their back to sleep (to prevent SIDS).
Give them tummy time when awake.
Switch their position during playtime.
Hold and carry them in different ways.
Limit long times in car seats, swings, or bouncy chairs.
Summary:
Positional head shape abnormalities, also called deformational plagiocephaly or flat head syndrome, are common in NICU babies, especially those born prematurely or who have been very sick and spend long periods lying in one position. Because a baby’s skull is soft and moldable, pressure on one area can lead to a flat spot, often noticed by parents as uneven head shape, flatness on one side, or a stiff neck. The good news is that with early attention — like tummy time when awake, changing the baby’s head position, physical therapy if needed, and sometimes helmet use for moPositional head shape abnormalities in NICU babiesre severe cases — most babies improve well. Prevention focuses on supervised playtime off the back of the head while always keeping the baby on their back to sleep for safety. Early recognition and simple daily adjustments can make a big difference in helping babies grow with a healthy, well-shaped head.
References:
APTA Paediatrics fact sheet 2022
Dr. Namrata Todurkar, MBBS, MD (Pediatrics), DNB (Pediatrics). Fellowship in Neonatology from National Neonatology Forum India. Fellow in Neonatal-Perinatal Medicine at the University of British Columbia. Areas of interest: Neonatal nutrition, Fluid and Electrolyte Management, Inborn Errors, Neurodevelopmental follow-up of preterm infants. Dr. Todurkar is a volunteer blogger at CPBF.
Comentários