Positional head deformities

Positional head deformities have dramatically increased in frequency following the recommendation by the American Academy of Pediatrics that all infants sleep on their backs to help prevent sudden infant death syndrome (SIDS). Prolonged and preferential positioning of the head can lead to a characteristic change in skull shape. The back of the head is usually flat on one side, and the ear and forehead on the same side are rotated forward. Generally, these deformities are easily differentiated from craniosynostosis by a thorough examination. A CT scan is necessary in some cases to differentiate this disorder from others requiring surgery.

Characteristic findings in positional head deformity include:

  • Flatness of the back of the head on the affected side
  • Flatness of the forehead on the opposite side
  • Rotation of the ear forward on the affected side
  • Fullness of the forehead on the affected side
  • A trapezoidal shape of the skull

When diagnosed in the first year of life, children can usually be treated non-surgically using band or helmet therapy. This involves making a plaster mold of the skull, from which a model of the skull is then made. This model is then rounded out and used to fabricate a form-fitting band or helmet that sits snugly against the prominent areas of the head. The flattened, recessed areas of the skull are permitted to gradually expand into the open areas of the band or helmet. Correction in skull shape usually occurs within three to six months. The helmet or band is made by a skilled orthotist working with a pediatric craniofacial surgeon, pediatric neurosurgeon or pediatrician.

In older children, craniofacial surgery is necessary only when deformities around the forehead and eyes are especially pronounced or incompletely masked by the hair. This surgery is similar to that performed for craniosynostosis.