Author name: Dr Michelle Cloete

The malleable skull of a baby is a soft structure that is designed to help them pass through the birth canal. It takes between 9-18 months for their skulls to fully form. The skull is very malleable in this time. It is especially so during the first 6 weeks of life. There are many different head shapes seen in infants and children. This can be alarming for a parent to notice and is important for primary health care providers, such as your chiropractor,to pick up.  At birth, an infant can also have a neck side preference and struggle to turn their head or keep their head turned to one side. During the first few weeks of life and between 9-18 months, babies can also DEVELOP a mishappen skull, where they lose the rounding of their skull and develop a flattening on a side of the skull. This flattening of the skull is referred to as plagiocephaly.  Plagiocephaly is a medical term that refers to abnormal changes in the shape and symmetry of the skull.  Causes of flattening of one side of the head in infants: Functional: body and head positional causes, harder laying surfaces, genetics (predisposition for softer and more malleable skull bones), joint restriction leading to further dysfunction. This can be linked to the neck side preference of the baby turning the head to one side more than the other, causing more pressure on that side and resulting in the flattening of the skull. Deformational: conditions like early suture closure (craniosynostosis) can also lead to skull shape abnormalities. Craniosynostosis is however only considered a diagnosis with an array of other signs and symptoms that a baby can present with. Risks of diagnosed plagiocephaly (change in head shape), if left untreated Abnormal head shapes are not purely cosmetic. For children with plagiocephaly there is a40% risk for neurodevelopmental delays if left untreated. There is also a risk of: jaw(temporomandibular joint) dysfunction (TMJ) – which would influence the latch and nutritive suckle; visual problems (optic nerve); craniofacial tightness (trigeminal nerve); headaches later in life and biopsychosocial problems (Drapeau, 2016) if left untreated. Why is chiropractic care important if my baby has a neck side preference? Not only does the positional effects of a neck side preference in a baby generally lead to a mishappen skull shape, but also sub-optimal latching to either the breast or bottle.  This can lead to more air swallowed and more cramping later in the day.  It can also have a longer lasting effect that can cause developmental problems such as delayed milestone achievement or asymmetricaldevelopmental patterns e.g. baby only rolling to one side. What will my chiropractor do to help my baby’s neck side preference or skull shape? The sooner your chiropractor can treat the joint restriction and dysfunction, the sooner your baby can show progress and recovery.  Babies are so resilient.  They just need to be nudged in the right direction. Treatment can be provided for associated conditions, such as a torticollis (a tight muscle on one side of the neck), which can cause a head tilt which constricts baby into one position.  Lifestyle advice such as tummy time, prone play, limiting the time your baby spends in swings or baby carriers while awake to resultantly encourage your baby to sit up and take pressure off the back of the head etc. will also be shared and encouraged and in so doing aid in baby’s recovery. Chiropractic care for infants and children are very important to help screen for and monitor an array of conditions that have and can be developed. A chiropractor who has a special interest in working with infants and children can help navigate the functional and developmental problems to head shapes.  Working with a cranial orthotist, lactation consultant, neurodevelopmental physiotherapist, paediatric occupational therapist also come into play according to the infant’s diagnosis. Please do note that it is still important for your baby to sleep on their backs as part of the recommendations of the ABC’s of safe infant sleeping. Babies should always sleep alone on their backs, in a crib. This reduces the risk of SIDS (sudden infant death syndrome).Remember: back to sleep, tummy to play rule! However safe, positional advice may be recommended to accommodate the healing process of the mishappen skull shape e.g. symmetrical movement and positional advice. Sources: Drapeau Annie (MD). Baby’s Head Shape: Should You Be Concerned? 2016www.nationwidechildrens.org/family-resources-education/700childrens/2016/12/babys-head-shape-should-you-be-concerned Kim DG, Lee JS, Lee JW, et al. The Effects of Helmet Therapy Relative to the Size of the Anterior Fontanelle in Nonsynostotic Plagiocephaly: A Retrospective Study. J Clin Med. 2019;8(11):1977 Burmeister S, Kayne A, Yazdanyar A, Hagstrom J, Burmeister D. 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