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Positional Head Deformity
What is Positional Head Deformity (PHD)?
Positional head deformity is grossly characterized by a flattening of the occiput with corresponding facial asymmetry.
What causes PHD?
With the initiation of the 'Back to Sleep' campaign the incidence of PHD had risen fivefold from an estimated 1 in 300 births to 1 in 60. The lack of time spent in prone can have detrimental effects on the shape of an infant's head, resulting in PHD. It is important to note that PHD is also often association with muscular torticollis. As the child develops a preference for positioning, the ipsilateral sternocleidomastoid muscle shortens resulting in torticollis.
How is Positional Head Deformity identified?
Common keys for diagnosis include:
- Ear Position - Ear on flattened side more anterior than other ear
- Facial Symmetry - Forehead protruding on the side of flattening
- Bald Spot - Unilateral bald spot
- Aerial View - "Parallelogram-shaped" head
How is PHD treated?
Physical therapy is recommended as the first defense toward remedying positional head deformity. Physical therapy aims to educate the child's caregivers about plagiocephaly as well as teach them exercises and positioning techniques that will correct the shortening of sternocleidomastoid muscle.
Implications:
Although positional head deformity is not a life threatening condition, the emotional costs of facial Asymmetry may be high. Persistent PHD and associated torticollis may also deter normal motor development and lead to visual motor difficulty. Early recognition is extremely important to initiate early intervention for treatment.
References:
Briggs WS (2003). Diagnosis and Management of Positional Head Deformity. American Family Physician, 67(9), 1953-1956.