Cranial asymmetry, or plagiocephaly, is the most common form of “flat head syndrome”, characterised by an uneven head shape in infants. Positional plagiocephaly (PP) results from prolonged pressure on one side of the head, predominantly due to the 1994 “Back to Sleep” campaign, which was implemented to reduce the incidence of Sudden Infant Death Syndrome (SIDS). While undoubtedly, any life saved due to safe sleeping guidelines is preferable to the higher rates of SIDS that led up to the development of the guideline, PP remains an unwanted side effect that does bear thinking about.
While many traditional healthcare providers prefer a ‘wait and see’ approach and only intervene in more notable cases of PP, that doesn’t mean that parents can’t seek support from a chiropractor. And it appears many have done so and gotten good results. While this comes from case report data, and we wait for larger studies to emerge before making larger claims, it shows a trend worth noting.
Since the widespread adoption of the “Back to Sleep” campaign, the prevalence of PP has significantly increased, ranging from 16 %to 48% of typical healthy infants younger than one year. This is compared to an estimated 1 in 300 infants before 1992. This surge has led to a heightened focus on investigating, managing, and preventing this condition. [1]
While the optimal timing and modality of interventions remain to be fully established, non-surgical treatments are the primary approach for plagiocephaly. These include observation, head repositioning, manual therapy techniques including chiropractic, and helmet therapy.
The following case report provides valuable insights into the potential benefits of chiropractic care for infants with plagiocephaly and other health challenges.
A five-month-old infant was referred to a chiropractor for plagiocephaly, colic and general well-being. The mother had previously sought care from a paediatric physiotherapist for plagiocephaly and was considering a cranial helmet. The family wanted a comprehensive approach, combining chiropractic care with physiotherapy and a helmet.
The infant’s mother had a history of health issues, including a fall during pregnancy, severe morning sickness, and a family history of scoliosis and depression. The infant was engaged during pregnancy, had a vaginal delivery with vacuum extraction, and experienced jaundice after birth.
The infant received 36 chiropractic adjustments over 12 months, including techniques focused on cranial alignment and upper cervical subluxations. The infant also wore a cranial helmet for 4.5 months.
After chiropractic care, the infant’s plagiocephaly improved significantly, as evidenced by a decreased cranial vault asymmetry index (CVAI) from 14.3% to 5.8%. Other improvements included increased neck range of motion, reduced primitive reflexes, and improved sleep quality. While the helmet was included in the infant’s care, which was indeed long-term, the notable change occurred when chiropractic was introduced. This may be due to chiropractic’s potential influence on restoring neck range of motion, among other things. The chiropractor used cranial techniques, gentle upper cervical subluxation adjustments, seated anterior thumb lifts, and ankle and hip mobilisations to care for the infant.
This led to:
- Significant improvement in plagiocephaly: CVAI decreased from 14.3% to 5.8%
- Increased neck range of motion
- Reduced primitive reflexes
- Improved sleep quality
While reduced primitive reflexes are noted as an aside in this case, it is not an insignificant one, with recent research linking retained primitive reflexes to neurodevelopmental disorders like ADHD and Autism. Thus, supporting their timely, or near timely, integration could be of considerable benefit across the lifespan.
We know that many chiropractors are interested in supporting the developing nervous system of the infant. So far, there is no alarming research on head asymmetry and neurodevelopment. However, there is some evidence that infants with PP but no neurodevelopmental delay may later develop delays in childhood, resulting in language disorders, attention deficits and learning disabilities. [2] Standardised measurements and definitions of mild, moderate, and severe PP are needed to identify babies requiring additional care in traditional medical settings, but chiropractors are able to support a baby regardless of their PP classification, as range of motion, muscle tone and other measures are regularly supported by paediatric chiropractors.
I.e. Parents don’t have to wait until it’s severe to benefit from chiropractic.
Neurodevelopment aside, residual craniofacial deformity has been linked to teasing, bullying, or embarrassment later on in life, which are among the most reported parental concerns relating to their child’s PP. [3] While research on PP and developmental delay is ongoing, the cosmetic benefits make prevention worthwhile.
Potential factors contributing to plagiocephaly include a small maternal pelvis, multiple births, breech position, limited amniotic fluid, male sex of the baby, gestational diabetes, first-time motherhood, high birth weight, large head size, vaginal delivery, prolonged hospital stay, prolonged labour, limited neck movement at birth, preferred head position, supine sleeping, and consistent head position during sleep. [4]
While this is just one case report, it aligns with several other chiropractic case reports, making this less of a standalone and more of a trend. This and other case reports show that there is something worth examining here, and opens up the possibility that putting your baby in the caring, skilled hands of a paediatric chiropractor as soon as head asymmetry starts to show may just be a good thing.
Reference:
- Ellwood J, Draper-Rodi J, Carnes D. 2020. The effectiveness and safety of conservative interventions for positional plagiocephaly and congenital muscular torticollis: a synthesis of systematic reviews and guidance. Chiropr Man Therap. 28(1):31. doi: 10.1186/s12998-020-00321-w. PubMed PMID: 32522230; PubMed Central PMCID: PMCPMC7288527.
- Miller RI, Clarren SK. 2000. Long-term developmental outcomes in patients with deformational plagiocephaly. PEDIATRICS. 105(2).
- Collett B, Breiger D, King D, Cunningham M, Speltz M. 2005. Neurodevelopmental Implications of “Deformational” Plagiocephaly. J Dev Behav Pediatr. 26(5):379–89.
- Parker M. 2019. Resolution of inability to latch, breastfeed, excessively recessed jaw & plagiocephaly in a newborn undergoing chiropractic care: a case report and & review of literature. J Pediatric, Maternal & Family Health. 7.
