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Infant Positional Skull Deformities

Like many parents, I can easily admit that after becoming a father I frequently worry for my children’s well-being. One of the more common balancing acts that all parents must deal with, is that of protecting their infant’s skull shape.

A child’s skull is quite moldable, especially during the first 2-4 months of their life. In the mid-1990s the American Academy of Pediatrics (AAP) introduced their “Back to Sleep” program, aimed at decreasing the incidence of Sudden Infant Death Syndrome (SIDS). Thankfully, this program has been very successful and has halved the risk of SIDS. Unfortunately, during the same time period, we’ve seen a rise in the number of children with skull deformities, such as a flattening of one area of their head. The American Academy of Pediatrics believes about 13% of population to have one of these deformities. Skull shape can also be determined due to pressures experienced at birth or in utero.

The good news is that with some very easy steps these deformities can often times can be improved or eliminated. In fact, positional training is the first recommendation for treatment in mild to moderate skull deformities. If there’s been limited success after the first 6 months of life, or for severe deformity, a cranial orthoses, known as a molding helmet, may be recommended. They work by providing pressure to the areas of the skull needed to correct the overall shape. Periodically, skull deformities are associated with a tight muscle in the neck, or torticollis. These individuals would benefit from a series of stretches and home environment modifications that healthcare providers can teach.

Skull deformities are one part of “container baby syndrome,” a number of different conditions that are developed as a result of an infant spending excessive time in a container such as a stroller, car seat, or swing. While these devices are made to promote safety and ease of travel, or for periodic play, prolonged periods of time can actually decrease movement of the baby. Long-term immobilization of children in these devices can actually lead to developmental delay in skills such as rolling, crawling, and walking. Furthermore, there’s now evidence that this type of immobilization may also lead to developmental delay in speech skills.

Physical therapy can also work to address the developmental delays found with container baby syndrome. Commonly treatment includes encouragement that the “Back to Sleep” positioning is for sleeping only, and recommending placement of the child in positions such as lying on its tummy, or holding the child in specific ways that encourage them to work at holding their own head up. Current recommendations ask that children get 30-60 minutes of laying on their stomachs every day. Besides preventing skull deformities, routine tummy time while awake has been shown to improve infant motor developmental scores during the first 15 months of life.

One situation that parents or caregivers often encounter is that of an infant crying when placed in the tummy time position. This is usually because the position requires more work, upsetting the child. As a result, oftentimes parents will wrongly view this position as unhelpful, and put the child back into a container. Physical therapy providers, however, will strongly recommend positions of work and play to increase strength and coordination.

Being the parent of a young child can be stressful at times. If you have questions, be sure to ask your Johnson County Hospital primary care or physical therapy provider about strategies to promote healthy growth and skull formation.

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