Flat head: causes, effects, and solutions

It is always difficult for a parent to see their child in discomfort or pain, especially when the pain starts to interfere with various aspects of their child’s activities, making them less sure-footed, less keen to join in the rough and tumble games of their buddies, and less able to sleep soundly through the night.

When Mick (not his real name), a little three year old, was brought into the clinic, his mother was distraught from staying up late at night massaging his neck. His complexion was pale, and his eyes were downcast. He was suffering from neck pain, headaches, and sensitivity to light.

He had developed a flat spot on the right side of his head, due to the right side of his neck being very tense, which pulled his head to rotate to that side whenever he laid down to rest.

This  then  affected the symmetry of his face, and his forehead and eye were protruding forwards more on one side than the other.

Part of the diagnosis given by the paediatrician was “ Torticollis with Plagiocephaly ” (flathead). And orthopaedich elmet was prescribed, in an effort to mold Mick’s head into a better shape. He wore this, starting at 4months old until he was 14 months old. The treatment was time consuming and required a lot of commitment, but did not yield the results that were hoped for.

Mick’s skull was still shaped asymmetrically, in the way  that is typical for children with plagiocephaly (see previous paragraph).

PicMonkey Collage def

The results were apparent after only five osteopathic sessions. From being a pale  child with downcast eyes, he changed and started regaining his bubbly self by the third treatment. He was moving around more, and even started to make it hard for me to hold him  down for treatment. He  continued growing faster  and healthier. By the fifth  treatment, he  couldn’t  hide his excitement when describing how  he loved jumping on the trampoline in his backyard!

The photos on the left were taken before treatment began, and the ones on the right show were taken after five sessions. His neck, which was previously straight and rigid, regained its normal backward arch. His skull completely changes shape. His face, which was almost flat before, with the upper and lower jaw held back, regains a considerable  amount of forward momentum for growth and expansion (see his chin).

PicMonkey Collage (1)

The change was further confirmed by the alignment of his ears.There was also a change in the contour of the left side of his head.

PicMonkey Collage 2

From his mother’s point of view,

“What I saw was an improved mobility, better running, better balance, better sleep from not  waking up with a sore neck. I used to be beside myself in the middle of the night massaging my two year old’s neck… A two year old is not supposed to have neck problems due  to pain. never gave him muscles relaxants but other parents may, to get the kid out of pain. He is normal in every other way but those physical limitations would have started to become more permanent and osteopathic treatment is less work fort the parent.

Helmets take  up so much time. He did wear the helmet  from  about 4 m to 14 months. We tried the physio therapy (at 4 m) and it worked but at 6 m, when he started to roll over in his  sleep, the head went back to it’s original flat spot. He kept rolling over because of the pulling  of  the muscles in his neck. The  Helmet helps the appearance but not the root cause. Physio can help (if caught in time) build the muscle but isn’t   the whole solution.”

So, what caused Mick’s condition?

From his case history,  we found out that during the last six weeks before his birth, Mick’s head was already engaged against the bony part of his mother’s pelvis. Where as some other infants don’t engage against the pelvis until right at the end of pregnancy just before labor  starts, Mick’s head was already engaged long before. This meant that for the six weeks before birth, his skull was being constantly compressed and squeezed.

This compression onto the skull often causesa buckling movement at the junction between the head and the top of the neck, which can compress many sensitive structures, including  the accessory nerve, a cranial nerve that, when irritated, may contribute to excessive firing  and tightness of the sternocleidomastoid and trapezius muscles at the side of the neck.

Also, the cranial bones are still quite plasticat that age, and can easily deform on prolonged pressure. The shape of the infant cranium  often responds to pressure just like a water balloon might; flattening on the areas where the most pressure has been applied, and bulging out in the other areas.

In addition, there are various soft connective tissues and fascia  that envelop the cranial bones, to hold the bones in correct relation to each other. If these tissues have been stressed or become tight in certain areas, they can hold a cranial bone in a twisted or shifted relationship to another one. In the longrun, excess tension in the fascia can also restrict the infant skull and face from continuing to expandand grow outwards fully.

We feel that any infant could benefit from a check-up to ensure  that  their bodies are functioning optimally. But are there any specific kinds of events that could cause restrictions in the infant that Osteopathy could help with?

1. Maternal conditions or diseases including:

•Hypertension (high blood pressure) or pre-eclampsia (syndrome that includes high blood pressure, urinary protein, and swelling)

•Maternal metabolic diseases, including diabetes (both pre-gestational and gestational types)

• Maternal family history of Cardiac, Renal, Lupus disease or Cystic fibrosis

• A high risk pregnancy

2. Timing patters:

• Premature delivery, premature cervical dilation, premature rupture of membranes

• Long labors (more than 14-18 hours into tal) are correlated to birth traumas and lowered initial health (APGAR score) of the new born infant, especially if it was the second stage of labor (the final pushing stage) that was particular prolonged.

•Also, if the baby had gotten stuck or delayed due to having difficulty maneuvering around the sacrum, tail bone and pubic bone of the mum during labor, tension patterns can show up in the skull which reflect the birth experience.

•If a vaginal delivery is interrupted part way through and changed to an emergency C-section, due to a drop in the baby’s heart rate, or a haemorrhage of the mother, this causes additional stress on the infant.

Amongs to her things, this sudden change in direction for the infant’s head from being pushed down on, to being pulled up against the suction force of the birth canal can also cause disrupted tension patterns in the infant’s skull.

If you have any further questions or inquiries as whether osteopathic manual therapy could be for you or your child,please feel free to contact me.

D.Os Vera Fittipaldi & Francine Tseng

*articol published for Intrinsi Osteopathic Clinic, Calgary (AB), Canada