From the Research
The term for plagiocephaly due to congenital muscular torticollis is positional plagiocephaly. This condition occurs when consistent pressure is applied to one area of the infant's skull, typically from lying in the same position repeatedly, and is often contributed to by torticollis, a condition where neck muscles are tight or imbalanced causing the head to tilt or turn to one side, limiting the baby's ability to move their head freely 1. The diagnosis of positional plagiocephaly can be made clinically and by physical examinations, with the simplest way to assess the severity of plagiocephaly being to use a diagonal caliper during physical examination, which measures the difference between the diagonal lengths on each side of the head 1.
Some key points to consider in the management of positional plagiocephaly include:
- Early intervention is crucial, ideally before 4-6 months of age when the skull is most malleable 2
- Treatment typically involves physical therapy to address the torticollis through stretching exercises, increasing "tummy time" when the baby is awake, repositioning techniques to reduce pressure on the flattened area, and in some cases, cranial orthotic devices (helmets) if the flattening is severe 2
- Most cases resolve with conservative management, and the condition doesn't affect brain development, though severe untreated cases may lead to facial asymmetry 3
- The use of helmet therapy may increase the initial rate of improvement of asymmetry, but there is no evidence that it improves the final outcome for patients with moderate or severe plagiocephaly 2
It's worth noting that the prevalence of positional plagiocephaly ranges between 19.6% and 46.6%, and treatment options include repositioning, physical therapy, and helmet orthoses, although consensus regarding the treatment of positional plagiocephaly remains elusive due to the condition's imprecise natural history, dissimilar diagnostic strategies, and unreliable data asserting treatments' efficacy 4.