Head and Neck Deformities

The helmet (cranial molding orthosis) provides a rounded surface, so your baby won't prefer to lay on the flattened spot. We have successfully used helmet therapy to treat plagiocephaly that has not been responsive to positioning. The helmet must be adjusted by the provider every two weeks to accommodate the rapid growth of the baby's head.

The length of helmet therapy typically depends on the age at which the child begins therapy. To be effective, the helmet must be worn 23 hours per day. More than one helmet may be needed to complete the therapy.

The most effective time to begin helmet therapy is when the head circumference is growing most rapidly, which in most children begins at approximately 4½ months. Cranial remodeling devices can be used effectively up to 18 months old, and in rare patients, even beyond that.

Deformational Plagiocephaly is one of the most common type of infant skull deformities and is normally noticed at about 6 to 10 weeks of age. It is characterized by an asymmetrical skull shape with a unilateral occipital flattening. The ear and forehead are both positioned more on the anterior side of the occipital flattening. There may be facial asymmetry, and can also be accompanied by torticollis, limited neck range of motion, weakness and preferential head positioning.

Plagiocephaly is becoming a worldwide concern. It occurs in up to 1 in every 50 newborns today. The condition is a deformity of the skull that occurs from the child sleeping in the same position, usually on the back, which causes the soft bones of the skull to become flat or abnormally shaped.

Treatment usually includes positioning the child differently (not on their back) if caught very early, and the use of an orthotic remolding helmet (helmet therapy). In severe cases, a surgical procedure can be performed to reshape the head.

Plagiocephaly is commonly associated with a neck deformity called torticollis, which is a congenital tightening of a neck muscle (sternocleidomastoid). This condition presents as an abnormal tilt or abnormal rotation of the head to one side or the other.

It is essential that torticollis is ruled out in any child who has plagiocephaly. If torticollis is not treated, then treatment for plagiocephaly will not be fully effective and the condition will persist. Torticollis is treated with physical therapy and an at-home stretching and exercise regimen.

Treatment options for torticollis at Pediatrix Surgery of San Antonio include physical therapy, Botox®, TOT™ collar, or surgery. Ninety percent of patients are treated non-surgically, but if surgery is needed, we offer both open and endoscopic repair for selected patients.