Positional plagiocephaly and massage

Editorial Team / Admin · Jan 11, 2006

Hi All -
My son was diagnosed yesterday with a borderline case of positional plagiocephaly and the doctor ordered physical therapy as treatment. I'm wondering if any of you have seen this ordered and what the actual treatment is? I understand that it's some form of massage, but I'm wondering if it's maybe more placebo for the parents (everytime we've been in to the doc, I've asked about it)? :)
He has no facial, ear asymmetry, it's really just that the back of his head is flat (although it's rounding out with some repositioning we've been doing).
Any info would be greatly appreciated.
Thanks so much...Missy

Hello, Missy,

In my experience, the use of banding and/or helmet has been the treatment. Now, not knowing to what extent your child has involvement, it is difficult to know whether PT would be benificial or not. I feel sure the PT would be performing repositioning techniques?

You might include these questions when talking with his physician:

http://www.plagiocephaly.org/support/questions.htm

Also, how old is your child? If more than 6 months, then you could pose the questions of utilizing an orthotic.

Here is a link for repositioning techniques:

http://www.plagiocephaly.org/support/repotech.htm

Here are some more links regarding positional plagiocephaly.

http://www.cranialtech.com/MedicalInfo/identifyplagio.html

http://health.groups.yahoo.com/group/Plagiocephaly/

mermette · Jan 12, 2006

Siri -

Thanks so much for your reponse...I looked at the links you provided.

My son is 6 monts old and he actually has what I would say is brachycephaly - a very mild case. The doc states that his sutures are still open and the anterior fontanelle is still open. He believes that the situation would probably take care of itself, but is using massage as a means of "pushing things in the right direction" (no pun intended). He doesn't feel there's any need for a helmet or band.

I had been unable to find any info online about massage for treatment, so I was wondering what it really entailed. I called the PT today and she's supposed to call me tomorrow to give me more info about the specifics of the treatment, the goals, etc. It should be interesting.

Thanks again for your response.

tomahawk · Jan 12, 2006

I just went to a lecture on positional plagiocephaly from a neurosurgeon at Barrows Neurological Center. I can't find my notes but his take on positional was that the brain will grow and push the skull out. The only "therapy" was to position the bed so the baby had to look or lay in a different position. If the sutures are still open, the head will round out. Brachycephaly has a suture fused and then there are 2 theories. One that the patient with one suture fused will be fine. The other is that there could be increased intracranial pressure and have knowledge deficit in the future. Some institutions were advocating cranial remodeling. The helmet was not for fused sutures but positional and he stressed that it wasn't necessary. Hope this helps. I wish I could have found my notes to get a name for you.

Editorial Team / Admin · Jan 12, 2006

Siri -
Thanks so much for your reponse...I looked at the links you provided.
My son is 6 monts old and he actually has what I would say is brachycephaly - a very mild case. The doc states that his sutures are still open and the anterior fontanelle is still open. He believes that the situation would probably take care of itself, but is using massage as a means of "pushing things in the right direction" (no pun intended). He doesn't feel there's any need for a helmet or band.
I had been unable to find any info online about massage for treatment, so I was wondering what it really entailed. I called the PT today and she's supposed to call me tomorrow to give me more info about the specifics of the treatment, the goals, etc. It should be interesting.
Thanks again for your response.

Hi, mermette,

The plan of action seems appropriate......repositioning. I feel fairly certain the physician wants PT to do this. As for the techniques employed......I don't know, but it sounds as if the massage is a form of repositioning.

I am glad you are staying in close contact with the plan of care/action. It never hurts to gather information and stay involved.

From what you are describing, it looks as if this will resolve nicely. I wish ya'll much luck. Please, let us know all about this. {{{{HUGS}}}}

mandana · Jan 13, 2006

We did PT with my daughter for mild positional plagio.

It was ordered because her neck and shoulder muscles were tight from her being in the same position all the time. I'm probably not explaining this well, but the sternocleidomastoid on one side really tightened up, and that's why she never moved her head from the same spot - so repositioning would fix the plagio, but PT would fix the muscle tension and allow her to reposition.

My brain hurts from studying all day, I hope this makes a teensy bit of sense. Anyway, she's one now and her head is nice and round and her neck is nice and straight. But be forewarned - she did NOT enjoy PT. :bluecry1:

Amanda

Gompers, BSN, RN · Jan 13, 2006

My nephew has positional plagiocephaly. He has always been a great sleeper, so from the time he was three months old, he'd sleep for 8-10 hours a night in the exact same position - on his back, with his arms above his head, and his head tilted to the right. Great for mom and dad, bad for baby's head!!!

He has diagnosed at his six month pediatrician visit. He got X-rays to see if the sutures were open or not, and they were. They first were going to do physical therapy. The doctor felt that massaging the neck and back muscles would loosen them and he'd be more likely to sleep in a differnt position. But the cosmetic issues were getting pretty severe (ears were asymmetrical already) so he ended up getting a helmet. They went to Cranialtech, and their website is listed in an above post. Very great people there, and they did a wonderful job with his helmet. This kid hated hats of any kind, still does, but he loved his helmet. Once he had it, he ended up sleeping on his side and belly because it was more comfortable with the helmet, so they didn't even do physical therapy since his ROM was fine.

He wore it for six months and probably should have worn it longer, but he was outgrowing it and they didn't want to put him through the molding procedure again (even though the company was so good with him during that traumatic process). So he's still kind of flat and his ears are still asymmetrical. It's much better though, it really was amazing how fast it worked!

One thing - they had to pay for it ($2000) out of pocket! I guess if the doc had ordered physical therapy as well, it would be paid for by insurance. But since they never ended up doing PT, it was considered cosmetic and insurance refused to pay! If that doc had only just sent him to PT, even for a few visits.... :madface:

mermette · Jan 20, 2006

Hi All -

Thanks to everyone who responded - the information was helpful.

We saw the PT on Wednesday and she's going to do a combination of neck massage and exercise to strengthen the neck and shoulder muscles evenly (she says there is an almost imperceptable torticollis). She's also going to use cranio therapy (manipulating the skull bones) to help them to reposition. Manipulating the skull makes me nervous, but she has a ton of experience. I explained what we were doing for repositioning during sleep, etc. so no changes there. I'm very comfortable with her and my son had a blast with her!

She says that the case is so mild that 6 - 8 sessions should do it. As well, he doesn't really need the full time with her, so we're going to do some other exercises/play to help encourage crawling, etc.

Overall...he's quite a normal baby with overly nervous parents! :chuckle

Thanks again...take care. Missy