Babies are turning up with flat heads more and more in Texas at least. However, there may be a trade off with preventing SIDS, or sudden infant death syndrome. This flat skull condition called plagiocephaly, a condition marked by an asymmetrical, flattening of the skull, appears to be on the rise since the American Academy of Pediatrics (AAP) recommended placing babies to sleep on their backs to lessen the chances of sudden deaths.
The study’s authors explain:
“Plagiocephaly is characterized by unilateral flattening of the head either in the frontal or occipital [rear] region. The presence of plagiocephaly has reportedly increased since 1992 while the American Academy of Pediatrics (AAP) recommended that infants be put to sleep on their back to reduce the risk of sudden infant death syndrome, although the plagiocephaly is then an acquired and not congenital condition.”
Between 1999 and 2007, reported cases of plagiocephaly increased more than 9 fold, from three cases per 10,000 live births to 28.8 cases. This resulted in 6,295 total cases with a definite diagnosis and was equivalent to an average annual increase of 21.2% per year. A large portion of the increase came from the Dallas region where the prevalence of plagiocephaly increased 23.2 times, from 2.6 cases per 10,000 live births in 1999 to 60.5 cases in 2007.
Since the AAP’s campaign, the incidence of SIDS in the United States has decreased by almost 40% while the incidence of flattened head syndrome has risen. Still, the prevention of SIDS is worth the increased risk of a flattened head, especially because positional plagiocephaly will often correct itself with appropriate intervention.
A baby might even start to develop positional plagiocephaly before birth, if pressure is placed on the baby’s skull by the mother’s pelvis or a twin. In fact, it’s not at all unusual to see plagiocephaly in multiple birth infants.
But the differences in head shape seen in children with positional plagiocephaly shouldn’t be confused with those caused by craniosynostosis, a more serious condition that occurs when skull bones fuse together too soon, causing an abnormal skull shape and possible brain damage if the condition is not corrected. A child with craniosynostosis may have deformities in the front of the head and a bony ridge over the abnormally fused skull bones. Craniosynostosis is usually corrected with surgery.
The study continues:
“We observed a statistically significant increase in the prevalence of plagiocephaly in Texas from 1999 to 2007. A small part of this might have been due to delayed compliance with the American Academy of Pediatrics recommendation for supine infant sleeping and a slight increase in preterm births. It was definitely not due to changes in birth defect coding practice, trends in multiple births or trends in clinical conditions like torticollis [having a twisted neck with the head tipped to one side, while the chin is turned to the other] or oligohydramnios [condition in which a pregnant woman experiences a deficiency of amniotic fluid]. Because the plagiocephaly trend was observed mainly in patients visiting certain health care facilities, among mild cases, and among minimally invasive procedures, we suspect it may be due mainly to changes in available therapies and insurance reimbursement practices.”
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Written by Sy Kraft, B.A.