Hello folks, I am Dr Katie and I am a part-time GP, a part-time student, and a full time wife and Mum to two little boys who are equal parts delightful and challenging. I chose the specialty of general practice for the care I can provide across the ages, and for the ongoing relationships I can develop with my patients and their families. I have a special passion for the care of children and young people and aim to provide high quality primary care to children of all ages. I am delighted to join Dr Meg’s team to write for you about some children’s health topics that I commonly encounter in my general practice. Today for my maiden blog post I will be talking about a common GP presentation – the misshapen head.

My mother is a Mum to 8 and a grandmother to 6 (so far), and has always been obsessed by babies’ heads. She loves to smell them, touch them, and kiss them. When I had my second baby a little early while she was on holidays interstate, she was quite upset with the thought that by the time she was able to get back to see him, he might have lost the newborn smell when she sniffed his head. Obsessed I tell you! And she is not alone. There is something utterly delicious and perfect about the head of a new baby.

But what if you are concerned that there is something not-quite-right about your baby’s head? In my practice I commonly see parents with their young babies seeking advice about the head shape of their little bundle of joy. One of the most common concerns is a noticeable flat spot, usually at the back of the head. This is an extremely common issue called plagiocephaly [pronounced “play-gee-oh-keff-ah-lee”] which translated from Ancient Greek means ‘Oblique head’.

How does plagiocephaly happen?

Those delicious heads of newborn babies are made up of multiple bony plates which meet at junctions called sutures. These plates can move about right up until the loose open sutures fuse (a process that usually starts around 6 months and continues until adulthood). This is ideal for the process of childbirth and allows the relatively large head of a newborn to descend through the relatively smaller birth canal. Many newborns have oddly shaped heads after birth secondary to the moulding that occurs during childbirth, or even from their position in the uterus. As the plates move around in those first few days and weeks, most of these heads change back into a more rounded shape. Some however do not, and it is worth checking in with your GP if you are concerned that your baby’s head is still misshapen after the first 4-6 weeks.

Positional plagiocephaly is the more common scenario that I see as a GP. This is a moulding of the head that occurs due to repeated pressure in the same spot, causing a flattening of that part of the head. The routine advice to sleep babies on their backs has been the single greatest factor in reducing SIDS deaths over the last 20 years or so. This has however, lead to a rise in positional plagiocephaly given the increased amount of time that babies now spend on their backs; sleeping, in car seats, and lying on the floor for example. Over time the pressure on the back of the head causes a flat spot, which may be more noticeable on one side or the other especially if babies have a preferred sleeping position with their head to the side.

How can I tell if my baby has positional plagiocephaly?

Plagiocephaly can be mild, moderate or severe.

There are no symptoms of plagiocephaly, but a sign that your baby has it is a flat spot at the back of the head, usually off to one side or the other. In mild cases this flat spot may only be noticeable if you look at your baby’s head from above. In more moderate or severe cases the forehead on the

affected side may be pushed forward a bit as may be the position of the ear compared to the other side, and there may be a difference in the fullness of their cheek on the affected side.

Do I need to worry about a flat spot?

Most plagiocephaly is benign, mild, and self resolves as your child spends more time upright and less in a lying position. Some cases are more severe and may indicate a more serious cause. Sometimes plagiocephaly can be associated with a tightness of one of the neck muscles in babies, a torticollis, which may be congenital and often needs correcting with physiotherapy before any positioning techniques to treat the flat spot will be effective. Sometimes we see plagiocephaly in babies with low muscle tone. Rarely, what is thought to be positional plagiocephaly may actually be something called craniosynostosis – a condition whereby the loose sutures between the skull plates fuse earlier than expected and cause problems with the growth of the skull. This is an important differentiation to make and there are some key differences that your GP or paediatrician can examine for.

What is the treatment for positional plagiocephaly?

For mild cases often no treatment at all is required and your child will grow out of this as they spend less time on their backs.

There are several small things that can be done at home to help your baby’s head shape normalise. Gentle head positioning towards the unaffected side when your baby is lying on their back can help. Alternating which end of the cot you have your baby’s head at can help encourage them to lie evenly on both sides. Encouraging frequent tummy time can take the pressure off the back of their head for a time and encourage development of the neck muscles which are involved in positioning. Likewise, baby wearing can help take the pressure off the flat spot on the back of the head and strengthen the neck. Having lots of interesting and stimulating activities or objects placed slightly on your baby’s non-preferred side can encourage them to turn more towards that side.

Sometimes your GP may refer you to a paediatric physiotherapist for some exercises, particularly if there is concern about low tone or torticollis.

If your child’s plagiocephaly is severe, or if there is concern about craniosynostosis then your GP may refer your child to a paediatrician or craniofacial unit for a review and/or some imaging of their skull.

Occasionally helmet therapy is still used for more severe cases, though this can be quite expensive, can be uncomfortable for babies, and there is little evidence that it actually works. If you are considering helmet therapy it is worth discussing the pros and cons with you doctor first.

So what should I do if I am concerned about my baby’s head?

Step one is a visit to your child’s GP who will be able to take a history, measure and examine your baby’s head, and discuss with you the recommended course of action.

Step two is try not to worry too much about the outcome of benign positional plagiocephaly. I have seen many a severely misshapen head correct itself over time with the simple techniques outlined above, and any remaining differences are generally not noticeable once covered in hair.

Most importantly if you are like my mother (and me admittedly) enjoy rubbing, kissing, and smelling your beautiful baby’s head before they get too old to let you do it anymore!

Well there it is folks, my very first blog post (look at me I’m a blogger). Stay tuned for my next post on a frustrating topic for kids and parents alike – warts!