Category Archives: Infants

Plagiocephaly and brachycephaly treatment

What Causes a Flat Head in Babies?

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Flat head syndrome is a condition that can appear at any time from birth, but it tends to take a few weeks or months to become apparent. Sometimes parents or health professionals notice that their baby’s head seems to have an altered shape with part of it appearing to be flat. If the flattening is severe enough, there can be asymmetry in the face and forehead with and one ear further forward than the other. There are a number of medical terms for this, including plagiocephaly, brachycephaly or scaphocephaly.

There are many different issues that can cause a flat head in babies, but they all stem from the fact that babies are born with soft skulls. Before a baby is born, the bone structure is not firm, but has to be soft and flexible to allow the head to descend through the birth canal. The bone plates in the head are not fused, but are held together with cranial sutures, which are essentially elastic tissues which need to be flexible to allow the brain to grow. Because the bones don’t fuse until the baby is a toddler, it means that the shape of the baby’s skull can be affected by a number of factors.

For example, the way that babies lay in the womb can affect their skull shape. This is especially the case with multiple births where there is less room for babies to move around. It is the same for babies when there is not much amniotic fluid in the womb. Because the skull strengthens considerably in the last few weeks of pregnancy as mineralisation occurs, premature babies tend to have much softer skulls which are more prone to becoming misshapen.

However, flat head syndrome most commonly occurs because of the baby’s sleeping position. This can be due to the very good advice to put babies to sleep on their backs or it can be due to a tight neck muscle on one side, called torticollis. The excellent ‘Back to Sleep’ advice has radically reduced instances of cot death. However, if the baby is positioned on their back for too long either in a cot, on the floor or on a firm baby carrier can result in the development of flat head syndrome. In mild cases, this will probably correct without clinical intervention and up to the age of four months it’s best to treat all babies simply through repositioning techniques. For example, babies can be encouraged to move their head by relocating mobiles and toys.

During the day when they are awake and parents are with them, it’s a good idea to place babies on their tummy which relieves pressure on the affected flattened part. Tummy time is a great form of exercise for your child and allows them to develop muscles in the hips and spinal extensors.

If you don’t see an improvement in your baby’s head shape after a month, it is best to seek advice from a medical professional who can suggest other possible interventions. These can include physiotherapy to increase the range of movement through to specialised bespoke helmets which will use normal growth to gently reshape the skull.

These helmets gently help the skull reform into the correct shape as the baby’s head continues to grow and fuse. The helmets are custom-made so that they fit each child perfectly and they are lined with soft foam to keep the babies comfortable. Babies are also reviewed regularly to ensure that they are responding properly to treatment.

In many cases, flat head syndrome can be corrected by repositioning, but more severe cases may need further intervention. It is important to realise that babies’ the growth needed to bring about correction is minimal when they reach about eighteen months, so it’s important not to delay seeking advice.

Plagiocephaly Infographic

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Parents often ask us what can be done to minimise plagiocephaly. So to help and to use as an education tool, we have produced a Plagiocephaly Infographic to explain how plagiocephaly develops and what should be done to minimise and treat the condition. We are sure that parents and clinicians will find it useful.

How to Recognise Signs and Symptoms of Plagiocephaly and/or Torticollis

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When your baby was only a few weeks old, you first noticed how he seemed to cock his head whenever he looked at you. When you watched him in other situations, you realised this was his customary posture. When you tried gently to move his head away from his shoulder, he cried as though you were causing him pain.
Looking back at your photo’s you notice that his head is always in the same position and he doesn’t seem to turn to the other side much.

Does this sound familiar? Your baby may suffer from what doctors call muscular torticollis or wryneck, a condition caused by spasms in the sternocleidomastoid muscle of the neck that cause the muscle on one side to contract. An infant or child with this condition appears to be tilting her head to one side while rotating his or her chin in the opposite direction. If you have witnessed any of these symptoms or suspect that your child may be affected by torticollis, it is advisable to seek medical help to confirm the diagnosis. Paediatricians estimate that up to 2 per cent of all infants may suffer from some degree of torticollis.

Sternocleidomastoid contracture is often the result of intrauterine positioning or a traumatic birth. When a baby is crowded so tightly into the uterus that he or she can’t move, contractures may develop and range of motion may be affected. Babies who are delivered with forceps, breach babies and multiples are all at higher risk of developing this condition. Torticollis is also rarely associated with infections and cervical abnormalities which your paediatrician will need to rule out before treatment can begin.

Untreated, torticollis can give rise to a host of problems in later life including facial and muscular asymmetry, visual disturbances, a delay in acquiring gross motor skills, and plagiocephaly or flat head syndrome, a persistent flat spot on your baby’s head.

While not every infant who shows signs and symptoms of plagiocephaly has problems with neck muscles, most infants with problematic neck muscles do go on to develop plagiocephaly because of their inability to move their heads. When your baby has flat head syndrome, you will notice that either the back or one side of her skull has sparser hair than the rest of his or her head, and that the underlying area appears to be flattened.

Flat head syndrome occurs when an infant spends too much time in one position. Infants’ heads are soft to facilitate the remarkable brain growth that takes place during the first two years of life. When one side of an infant’s head spends too much time resting against a flat surface, the skull can actually be moulded. Other causes of flat head syndrome include intrauterine positioning and spending too much time lying supine. When the Foundation for Sudden Infant Deaths (FSIDS)publicised guidelines to recommend that infants younger than one year old always be put to sleep on their backs, paediatricians saw a striking rise in plagiocephaly incidence.

The treatment for torticollis often involves physiotherapy. The therapist will work on exercises that gently stretch the sternocleidomastoid muscle to increase range of motion. Parents will be given a program of exercises that they can do with their baby at home.

Flat head syndrome can often be corrected by simply repositioning a baby’s head so that he or she is never lying on the flat spot. In severe cases, a custom-moulded helmet will improve the head towards a more normal and acceptable shape.

How to Treat a Baby with a Flat Head (Plagiocephaly)

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Plagiocephaly, commonly known as flat head syndrome, is the medical term for a condition that affects as many as two out of every ten babies. Flat head syndrome develops when a baby repeatedly lies in the same position. This can occur when parents aren’t aware that they need to change an infant’s position during the day or because of problems with neck muscles. An infant’s skull is so soft that flat surfaces can actually mould the shape of an infant’s head. Since 1992 when the American Paediatric Society began recommending that infants sleep on their backs to prevent SIDS (Sudden Infant Death Syndrome), paediatricians have seen a six-fold increase in flat head syndrome. This experience is reflected in the UK since this advice was adopted. Babies must always be placed on their backs to sleep and this has saved thousands of lives. During the day when they’re awake and Mum is with them, babies should be placed on their tummies and pressure relieved from the back of the head.

Plagiocephaly may be associated with brachycephaly, a type of flat head syndrome where the head shape is very wide and the flattening appears across the back of the head. With brachycephaly, the back of an infant’s head flattens uniformly, causing the crown to be wider and taller while the distance between temples and chin may be longer. Brachycephaly is also classified as flat head syndrome, and responds to many of the same interventions.

Parents are usually the first to be aware of flat head syndrome. They may notice a flat spot on the back or side of their infant’s head where hair growth is noticeably sparser. Their baby’s ears may not be symmetrically aligned or some other facial asymmetry may be present. When torticollis, a tight neck muscle is a factor, a baby’s head may appear to be tilted to one side the much of the time.

In the vast majority of cases, plagiocephaly caused by a restrictive sleeping position responds to simple therapies. Yet the diagnosis itself can be so intimidating that some parents may be frightened of interacting with their babies in a normal way that includes tummy time and playing to relieve pressure on the flat spot. A baby with a flat head is no more fragile than any other baby.

Repositioning techniques are the best intervention for simple flat head syndrome. You’ll want to position your baby in his or her crib so that the affected side is not lying flat. When your baby is lying down, encourage active turning of the head by hanging a mobile or some other bright object where the baby will want to look at it. Limit the time your child spends in car seats, carriers and pushchairs with flat backboards that press up against his or her head. When holding, feeding, or carrying your baby make sure to reposition so that the flat spot is not pressing against you. Slings and other baby carriers which position your baby’s face towards your body benefit a baby with a flat head by decreasing the amount of time spent with pressure to the back of the head.

Some parents misinterpret the Foundation for Sudden Infant Death (FSID) guidelines to mean a baby should never be placed on the tummy. This is simply not the case. Supervised tummy time is good for your baby. Tummy time helps babies develop control of their head and neck muscles and overall hip and spine development, it also encourages bonding, particularly if you are comfortable enough to get down and interact. Try putting your baby’s rattle and toys just out of reach so he or she is encouraged to reach for them.

More severe cases of flat head syndrome may require physiotherapy and/or a corrective helmet. If your interventions don’t seem to be working, research the alternatives which will be able to help.

TiMband Treatment for Plagiocephaly

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TiMband

PlagioCare treatment will now be known in the UK and Ireland as the TiMband. PlagioCare has been in existence for three years and has successfuly treated thousands of infants in the UK and Europe.

We believe it is the best plagiocephaly or flat head syndrome treatment system available due to its rapid results, lightweight helmet style, brilliant child friendly photographic scanner and final verification of treatment for all parents with before and after scans with software to review at home. The treatment is exactly the same, it’s only the name that is changing.

The Benefits of Your Child Wearing a Plagiocephaly Helmet

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Plagiocephaly remodelling bands or helmets are a safe, non-invasive treatment for an asymmetric or unusually wide head shape. They do not interfere with his or her emotional or social development and are similar in action to teeth bracing in older children and young adults. The helmets are lightweight and available with a range of patterns. They let babies continue to be babies, but ensure corrective alignment and a more normal head shape that will allow your little one to participate fully throughout schools years and into adulthood.

What Is Plagiocephaly?

Plagiocephaly is the medical term for a common condition in which the back or one side of an infant’s skull shows significant flattening. It is often noticed as the bald patch that infants develop appears to be on the flattened side of the head. Clinical reports estimate that plagiocephaly may affect as many as one out of every 30 infants. Babies are born with soft, mouldable skulls so that they can pass through the birth canal and continue to be flexible to accommodate the rapid brain growth that occurs in the first two years after birth. When infants spend a lot of time sleeping with their heads in one position, a positional or developmental plagiocephaly may result.

In most cases, the early signs of positional plagiocephaly are detected by parents or grandparents and the first thing to do is to simply by reposition the head away from the flattening while he or she sleeps. Babies must always be placed on their back to sleep. Some infants with a flattening will need more targeted intervention and this can be physiotherapy or osteopathy to help release a tight muscle allowing full range of motion in the neck. If this is unsuccessful, a helmet will return the head shape to a more normal shape gently and quickly. If you do decide that helmet therapy is the appropriate choice, there is plenty of help and advice available to you.

Helmet Therapy for Plagiocephaly

Helmet therapy works by applying a gentle, continuous pressure to your baby’s developing skull, rounding it out throughout the day. This pressure does not hurt, and once your baby gets used to wearing this new piece of clothing, it will not interfere with any of your baby’s normal developmental activities. The helmet is adjusted so that your baby’s head can keep growing normally. It is made to an accurate photographic scan of your baby’s head shape and is made of light foam with a semi flexible shell is moulded. Helmet therapy may be recommended between four and five months if repositioning therapy has proven ineffective. Treatment effectiveness varies with the age of the infant and the severity of the plagiocephaly, but in most cases, your infant will usually wear the helmet for about five months.

Advantages of Helmet Treatment

There are many advantages to plagiocephaly helmet therapy. It will lead to a more normal symmetric skull shape, which will allow children to participate more fully in sports activities for which they will need to wear protective headgear. A more symmetric skull means more symmetrical facial features! This can affect many aspects of your child’s subsequent life.
Helmet therapy will also reduce disorders that may occur in later life due to asymmetry. Many dentists now believe that TMJ (temporomandibular joint disorder) is due to a misalignment of the jaw. TMJ is often linked to severe pain and speech disorders in its adult sufferers.

Helmet treatment, when indicated, will help your baby with plagiocephaly grow into the happy, healthy child with all the potential for future life
Since 2003 Technology in Motion has been providing treatment for plagiocephaly and brachycephaly (flat head syndrome), conditions which involve the deformation of the head of an infant.

What is Plagiocephaly and Brachycephaly (Flat Head Syndrome)?

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Plagiocephaly is the word that is used to describe a diagonal asymmetry across the head shape. This word particularly describes a flattening which is to one side at the back of the head and there is often some facial asymmetry. Brachycephaly describes a very wide head shape with a flattening across the whole back of the head. We usually see babies who have a combination of these two problems.

Brachycephaly & Plagiocephaly

Symmetric brachycephaly before treatment

Parents usually notice that their baby has an irregular shaped head at about 8 weeks old and are usually told that it will correct itself naturally and that it is just cosmetic.
Our advice is that as soon as flattening is noticed, then a parent should immediately start to reposition their baby. You can find information on this on our repositioning guide. This can assist in preventing the condition worsening and hopefully start to see improvement starting. If natural improvement of the plagiocephaly available it will happen in these first early few weeks of life. For an infant under four months of age we recommend repositioning.
Will my baby’s plagiocephaly self correct?
Our experience is that if the plagiocephaly or brachycephaly is not improving on its own by five months of age then it probably won’t improve greatly without some assistance. The treatment that we use to correct flat head syndrome is a PlagioCare treatment which rapidly accelerates return to a normal head shape. Treatment time for plagiocephaly depends on a baby’s age and takes between three to six months. The image below shows before and after images in a typical case of plagiocephaly with a brachycephaly. This little boy achieved this result after only nine weeks of treatment.
Since 2003 Technology in Motion has been providing treatment for plagiocephaly and brachycephaly, conditions which describe a head shape deformation. We usually have over 100 infants in treatment at any one time and we are widely regarded as the leading clinical team managing flat head syndrome.

Flat Head Syndrome: A Basic Understanding

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Flat Head Syndrome is a general term applied to infants whose cranial development results in a flat area on the back or side of the head (deformational asymmetry). The deformation may be present at birth, or may become apparent during the first few months of the infant’s life. The two most common forms of the syndrome are plagiocephaly and brachycephaly. The term plagiocephaly is used to describe a flattening at the side of the head in the parietal region, above and behind the ear. Facial asymmetry may be noticeable on the forehead and there may be misalignment of the eyes and ears. When the flattening extends across the back of the head and the head is wider than usual, in this event the length to width ratio (cranial index) is outside of the normal, this head shape is known as brachycephaly. It is quite usual to see a combination of brachycephaly and plagiocephaly, showing as a wide, asymmetric head shape.

Causes of Flat Head Syndrome

Cranial birth deformities can be the result of intrauterine restriction which can be caused by several different factors. Positional moulding in the uterus (in utero moulding) occurs due to the inhibited position of the baby in the womb. It is more frequently seen in multiple births due to the restricted positioning of the babies and their heads. In other cases deformities of the head present at birth can be the result of birth injury caused by methods of assisted delivery (intrapartum moulding). There is also a greater incidence of plagiocephaly developing in infants born prematurely as their heads are much softer. Fortunately, the majority of these deformities caused both in the uterus or during birth improve naturally without need for treatment during the early months of the infant’s life. The exception occurs when for whatever reason when the infant is positioned in a way that exerts more pressure on one part on certain area of the head. In this case, the syndrome may worsen by simple gravitational force turning an initially minor plagiocephalic deformity into a potential long-term problem requiring treatment.

Besides deformities present at birth, paediatricians have reported increases in the number of children with cranial deformities in recent years, particularly unilateral flattening of the occipital bone at the back of the head. This increase has been, at least statistically, compared with the significant decrease over those years in the numbers of cot deaths or SIDS (Sudden Infant Death Syndrome). The connection assumes that the increase in flat head syndrome can be attributed to parents following the positioning recommendations aimed at decreasing the risk of SIDS; specifically, the recommendation that healthy young infants should be placed down on their backs for sleep. The back to sleep advice has reduced Sudden Infant Death significantly and parents should always place their babies on their backs when sleeping. However, during the day when the infant is awake and the parents is with them they should spend at least half of their waking hours without pressure on the back of the skull to allow it to reshape naturally. If no improvement is beng seen by the age of five months then plagiocephaly treatment should be considered.

Treatment of Flat Head Syndrome

Initial treatment usually involves repositioning of the baby onto their tummy to reduce the pressure on the affected area, known as ‘Tummy Time’. This should be done for extended time periods during the day. In addition, repositioning cots and other areas in which the infant spends their day will force them to look in different directions to see parents or other areas of interest around them. It should be noted if the infant cries or appears to have discomfort when they are repositioned as this may indicate a problem with neck pain and this possibility should be addressed as tightening of the neck muscles can be common in infants. This treatment should continue until the age of 5-6 months.
If the problem remains unimproved, parents should consider treatment of flat head syndrome with a helmet for a child while still less than 14 months of age. The ideal time to begin treatment is 4 to 7 months but correction can be gained from starting treatment up to 14 months of age. A cranial remoulding helmet (orthosis) can be designed that provides painless contact over the prominent areas of the skull while leaving protected voids to provide a pathway for growth by the affected areas for more symmetrical skull growth.

Treatment for Brachycephaly: A Mum’s Story

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Harry is a lovely little 8 month old boy with severe brachycephaly; often referred to as ‘flat head syndrome’. The condition brachycephaly is best described as a flattened area at the back of the head where the width of the head can be wider than the length.
Harry’s mum began to realise that his head was becoming flat at around 6 weeks and raised her concerns with his health visitor who advised mum to reposition, and that in time the flatness would round out. However mum grew increasingly concerned as over time Harry’s head shape did not improve and in spite of repositioning, Harry’s head shape continued to deteriorate.
When Harry was 6 months old Harry’s mum took him to the GP as the flatness was really worrying her by now and they then referred him to a consultant at Addenbrookes hospital. Harry had a CT scan which ruled out the medical condition craniosynostosis, (early fusion of the bones in the head) but his parents were told there was no more that the NHS could do to correct his head shape. Harry’s parents felt really let down by the NHS as the consultant himself agreed that Harry needed to have a helmet but they could not fund it!
Mum read about The Tree of Hope children’s charity just by chance whilst reading a newspaper article on the internet regarding a baby who was given money by the charity towards the funding of treatment for a helmet. The application process was very simple and quick, and within 6 days they were given the great news that the charity would pay all the money towards Harry having treatment. The Tree of Hope is a small yet wonderful charity offering hope to families who require specialist medical treatment. Jeremy from the Tree of Hope was quoted as saying “The Tree of Hope Children’s Charity is delighted that we were able to help Harry and we are thrilled that he is making such good progress.”
Harry’s parents chose to go to Technology in Motion as all the feedback from other parents on internet forums was extremely positive, they had also seen an episode of the Channel 4 programme ‘Embarrassing Bodies – Kids’ which featured TiM and this reassured them that Harry would be in the best hands for the course of his brachycephaly treatment.
At the assessment Harry’s head was measured and scanned and his cranial ratio was found to be 105% which is regarded as very severe. The cranial ratio is the relationship between the width and length of a head with a normal cranial ratio sitting between 78 %and 83%. The aim of the treatment will be to hold the width of Harry’s head and allow all the growth out of the back of Harry’s head thus reducing the cranial ratio.
Mum stated that their clinician was brilliant with Harry and that they explained the process very clearly. The assessment was very relaxed – Harry was even having his lunch whilst being scanned!
Steve Mottram, Managing Director of Technology in Motion said ‘Sadly, Harry’s story is very common and we hear similar stories from many of the parents that we see. The one unusual and hopeful part is that the doctor did recognise that Harry would be helped by using a helmet to treat the plagiocephaly. Most parents are not given a diagnosis, advice on repositioning or information on treatment which is always successful if caught at an early enough age.’
Harry will be fitted with his helmet on Wednesday 7th Dec and we will keep you updated with his progress.
Technology in Motion treat infants with flat head syndrome; plagiocephaly and brachycephaly in several clinics across the UK. Please visit their website for more information.

Technology in Motion Open New Plagiocephaly Clinic in North London

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Since becoming an independent company, acquired from Össur by Steve Mottram and Sandie Waddell in July this year, Technology in Motion Ltd has continued to develop and flourish. Based on the core principles of; excellence in clinical care, respect for client confidentiality and professionalism in all that we do, our clients are secure in the knowledge that their care and that of the babies that we treat for plagiocephaly is in the very best hands.

One of the many quotes from a client is: ‘We have been totally impressed and delighted with the care and professionalism that has been shown to our son by Steve and Sandy. They are indeed a credit to the Healthcare that is available in this country, and they are undoubtedly the leaders in their field.’

Technology in Motion is now delighted to announce the start of further expansion by our association with North London’s Prestige Healthcare clinic in Barnet. This is our second London clinic complimenting our existing Wimbledon clinic and is our sixth UK clinic ensuring that we continue to meet our clients’ needs by delivering a high quality local service.

Our partnership with Prestige Healthcare means that we are now able to deliver a local North London service offering the very best to our clients. This clinic offers all of the services that Technology in Motion is known for and our clients find that it is now easier for them to access our services.

Technology in Motion continues to offer a national service for correction of head shape deformity such as plagiocephaly and brachycephaly (flat head syndrome) for young infants and knee bracing for sport injury or arthritic problems and we choose the very best brace to relieve the problems for which our clients seek our services.

We continue to be the UK’s leading provider of cranial remoulding treatment and since introducing this therapy to the UK in 2003 we have treated thousands of babies nationwide. We are always looking to further the support and care that we give to clients, whether they be babies with plagiocephaly and brachycephaly or adults with knee injuries such as an ACL rupture to continue their sport or for daily use or to relieve the pain of knee osteoarthritis.

Steve Mottram, Managing Director and the UK’s leading cranial specialist says:

‘We at Technology in Motion are delighted that the transition from a wholly owned to an independent company has gone so smoothly. Our clients continue to compliment us on our services and we strive to make their experience with us one which exceeds their expectations. This new phase of our development, working with the clinicians and staff at Prestige Healthcare at their new centre is another milestone in the company’s journey. We are impressed by the facilities and the clinicians and know that our clients will receive excellent care in this new location. ‘

For more information, visit us at: www.technologyinmotion.com, call us on 0330 100 1800 (local rate) or email us at info@technologyinmotion.com

Founded in 1993 Technology in Motion has been offering clinical service for all orthopaedic conditions requiring orthotic intervention. It continues to offer PlagioCare™ treatment for infants with plagiocephaly , the fitting of knee braces; CTI braces for knee ligament injuries or bracing for knee osteoarthritis.