Newborn

Care of the head of the newborn baby to avoid malformations


Newborn babies are more and more frequent with a malformation of the skull, which is known as plagiocephaly. Can this deformation of the skull be avoided? When it occurs due to intrauterine causes, the child must be directly treated, but if the child is born without any alteration, the parents must take special care in the head of the newborn baby to avoid malformations.

Every day I admire the greatness of nature more, especially when a baby is born vaginally, since it allows it to pass through a canal that is quite narrow. And he does it 'without problem' because the structures of his skull, which are soft bones, have the ability to overlap and compress to fit the narrow canal of the vagina; thus, in this way, through a process called 'molding', the fetus comes out without complications most of the time.

In this process, not only the six bones of the skull (frontal, occipital, 2 parietal and 2 temporal) work, but also other structures called fontanelles and sutures play an important part in the modeling process.

The main fontanelles are anterior and posterior and they remain open until a certain age to allow the baby's brain to grow and develop. The anterior fontanelle closes between 9 to 18 months and the posterior fontanel between the first and second month of the child's life. If there is a premature closure of the same, it must be evaluated periodically to observe the presence of complications, which is known as 'craniosynostosis'.

Of course, when our baby is born, we expect everything to be perfect, but if it is born vaginally, its head is usually cone-shaped, which becomes rounded as the days go by; sometimes this deformity can be maintained, so we must consult with the pediatrician to find the solution.

When I receive newborns in my office and carry out a thorough physical examination, one of the parts that catches my attention is the head, which I check for any deformity or alteration of its structures, not only that it is visible, but also palpable, and one of the most frequent deformities is plagiocephaly.

The plagiocephaly It can be defined as an asymmetric deformity of the skull, produced by a constant pressure, exerted on the same region of the skull, which can be observed from the birth of the baby or can develop in the first weeks or months of life.

It can have its intrauterine origin (prenatal causes), especially when there are multiple pregnancies, due to the little space between the fetuses, which leads them to have abnormal positions that constantly compress the skull, or also in pregnancies with oligoamnios, where there is not enough amniotic fluid to cushion the baby's movements in the womb.

The other origin or cause of plagiocephaly can be extrauterine, also called positional (postnatal causes), due to the position that the baby adopts at bedtime, that is, the same posture constantly, which makes the bone tend to sink on that side (the bones are soft until a certain age of 14 to 18 years) and then produces the asymmetry of the head.

In recent years the frequency of these cases in the pediatric consultation has increased gradually, currently having an incidence of 40% in children under 1 year of age. This is explained because from the year 92 to now, with the aim of preventing sudden baby death syndrome, the position of newborns when sleeping has changed a lot. Now it is recommended to sleep on the back, so if the baby is always placed on the same side or in the same way, there will be constant pressure on that part of the skull, which will cause plagiocephaly.

Last month, an infant less than 2 months of age with positional plagiocephaly at the level of the occipital bone (head flattened at the back) was brought to the consultation. I explained to the parents, who were very concerned, that it is a pathology that has a simple treatment if it is before three months of age and that it consists of:

- When sleeping, place the baby on his back in the crib, on the prominent side of the head.

- Place it face down as long as possible, when awake only.

- Use special pads, who have a depression so as not to support the affected bone.

- Do neck exercises when there is associated pathology in this area, such as torticollis with plagiocephaly.

If after 3 months there is no improvement, the behavior is orthopedic, which should be carried out before one year of age, since there would be the risk of maintaining plagiocephaly due to the closure of the fontanelles and sutures.

The orthopedic treatment is performed by placing what is called an orthopedic band, which is placed around the head and will have pressure points in the places that are required. The results are very encouraging.

48% babies with plagiocephaly who do not receive treatment on time may have complications as they are:

- Aesthetic consequences that in the future can generate severe self-esteem problems, especially due to the bulliyng that may be caused by their own friends, schoolmates and even family members.

- And possible psychomotor and cognitive delay, since areas of the brain can be altered due to lack of development.

My patient is currently on positional therapy and looks much better, so I conclude by insisting that the most important thing to prevent plagiocephaly from occurring is prevention, of course as long as it is positional, so I recommend:

- Change the position of the head every three hours, while the baby is sleeping in the crib, interspersing the right side and the left side.

- When you are breastfeeding, avoid that the baby's head is constantly pressing on the mother's forearm, that is, it is best to change positions when breastfeeding.

- As long as the baby does not turn over on his own, place him on his stomach frequently when awake.

- Consult with the pediatrician as soon as possible if you observe any deformity of your baby's head.

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