Take Good Care: Local News
Back Sleeping and Misshapened Heads
Can the epidemic be something that’s actually good for the health of children?
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Story Updated: Sep 8, 2011
As pediatricians, we see a steady stream of infants who have oblong or misshapen heads, and the incidence of this is increasing. Good. The more the better!
How can this be? Can the epidemic be something that's actually good for the health of children?
A little history: In 1992, as evidence mounted that Sudden Infant Death Syndrome (SIDS) could be associated with infants sleeping on their stomachs, the American Academy of Pediatrics swung into action. To this day, we do not know the cause of SIDS, and it is still the leading cause of death in infants aged 1-6 months. Several sleeping styles and habits have been associated with SIDS, including sleeping in the same bed as parents, sleeping on soft bedding, and parental smoking. The most prominent risk factor, however, was sleep position. In numerous studies of infant sleep position, SIDS was 2 to 11 times more likely in infants who slept on their stomachs compared to those who slept on their backs. This was a public health no-brainer, and the American Academy of Pediatrics recommended in 1992 that all infants be placed supine for sleep, the so-called "Back to Sleep" campaign. In 1992 only 13% of infants were put to sleep on their backs; now the percentage is more than 75%. Along with this, the incidence of SIDS has dropped 50%, a major success story.
Not surprisingly, the incidence of children with skull malformations has risen by 40%. Pediatricians always know when infants have been placed on their back to sleep. At the very least, they will have a bald spot on the back of their heads. Many, however, will present with an actual flattening of the back portion of the skull, called deformational plagiocephaly. In Greek, plagio- means "oblique" and -cephaly means "head", a wholy accurate description. The jury is still out on the significance of this misshapen head. Most pediatricians feel that the shape is a solely cosmetic issue that children outgrow with time. After all, infants begin rolling at around 4 months of age, thus sleeping position cannot be guaranteed (luckily the incidence of SIDS begins plummeting at this age). A few authors have hinted that positional plagiocephaly may be associated with mild developmental delay. Even these authors, however, defer to the overwhelming success of the "Back to Sleep" campaign, and continue to encourage parents to place children on their backs.
Not every misshapen head is benign however. Infant heads, as everyone knows, have a "soft spot," which exists because the skull bones are still growing together. The growing takes place from the sutures, the lines where the five bony segments that make up the infant skull come together. If any one of these sutures is fused, a condition called synostosis, the skull will not grow outward from that suture, causing a similar shape of the head. This condition exists from birth, differentiating it from positional plagiocephaly which forms after the infant has been sleeping on his or her back for weeks to months. Synostosis, although rare, is a potentially serious condition, and delicate surgery is often required to ensure that the skull, and by extension the brain, can continue to grow normally. Parents should seek the opinion of their pediatrician if there is any question.
So what's a parent to do? Grin and bear it? The AAP has recognized the increased incidence of skull deformities and recommends that every infant should have "tummy time" while awake. This not only lessens the likelihood of an abnormally shaped head, but helps with the development of neck and shoulder muscles. Parents should also alternate which direction they place their infant in bed, so that 50% of the time the child turns their head to the right to any stimulation in the room, and 50% of the time have to turn their head to the left.
Any physician in any field would be ecstatic to find a treatment that reduces death by 50%, especially one as simple as sleep position. The number of deaths from SIDS in the United States has plummeted from over 4,800 in 1992 to less than 2,300 in 2004, a truly remarkable statistic. Flat heads in infants are undeniably caused by back sleeping, but this is one side effect that, given the alternative, any parent will be willing to accept.
Timothy Gibson, MD is director of the Hanshaw Pediatric Hospitalist program at the UMass Memorial Children's Medical Center. He lives in Sterling with his wife and three children.
Not surprisingly, the incidence of children with skull malformations has risen by 40%. Pediatricians always know when infants have been placed on their back to sleep. At the very least, they will have a bald spot on the back of their heads. Many, however, will present with an actual flattening of the back portion of the skull, called deformational plagiocephaly. In Greek, plagio- means "oblique" and -cephaly means "head", a wholy accurate description. The jury is still out on the significance of this misshapen head. Most pediatricians feel that the shape is a solely cosmetic issue that children outgrow with time. After all, infants begin rolling at around 4 months of age, thus sleeping position cannot be guaranteed (luckily the incidence of SIDS begins plummeting at this age). A few authors have hinted that positional plagiocephaly may be associated with mild developmental delay. Even these authors, however, defer to the overwhelming success of the "Back to Sleep" campaign, and continue to encourage parents to place children on their backs.
Not every misshapen head is benign however. Infant heads, as everyone knows, have a "soft spot," which exists because the skull bones are still growing together. The growing takes place from the sutures, the lines where the five bony segments that make up the infant skull come together. If any one of these sutures is fused, a condition called synostosis, the skull will not grow outward from that suture, causing a similar shape of the head. This condition exists from birth, differentiating it from positional plagiocephaly which forms after the infant has been sleeping on his or her back for weeks to months. Synostosis, although rare, is a potentially serious condition, and delicate surgery is often required to ensure that the skull, and by extension the brain, can continue to grow normally. Parents should seek the opinion of their pediatrician if there is any question.
So what's a parent to do? Grin and bear it? The AAP has recognized the increased incidence of skull deformities and recommends that every infant should have "tummy time" while awake. This not only lessens the likelihood of an abnormally shaped head, but helps with the development of neck and shoulder muscles. Parents should also alternate which direction they place their infant in bed, so that 50% of the time the child turns their head to the right to any stimulation in the room, and 50% of the time have to turn their head to the left.
Any physician in any field would be ecstatic to find a treatment that reduces death by 50%, especially one as simple as sleep position. The number of deaths from SIDS in the United States has plummeted from over 4,800 in 1992 to less than 2,300 in 2004, a truly remarkable statistic. Flat heads in infants are undeniably caused by back sleeping, but this is one side effect that, given the alternative, any parent will be willing to accept.
Timothy Gibson, MD is director of the Hanshaw Pediatric Hospitalist program at the UMass Memorial Children's Medical Center. He lives in Sterling with his wife and three children.