LES DÉFORMATIONS POSITIONNELLES

Qu’est-ce qu’une déformation positionnelle ?

Une déformation positionnelle correspond à une déformation de la forme de la tête du nourrisson qui apparaît au cours des premiers mois de la vie, lorsque le crâne est particulièrement mou et fragile.

À mesure que le cerveau du bébé se développe, les os du crâne se dilatent progressivement pour offrir un espace adéquat. Si une force extérieure (par exemple, une surface plane comme un lit d’enfant) limite cette expansion dans une zone particulière du crâne, la croissance sera compromise dans cette zone.

Ils sont classés en fonction de la zone du crâne affecté, bien que des formes combinées puissent aussi se produire.

La plus fréquente est la plagiocéphalie, qui représente jusqu'à 85% des cas.

quelles sont les causes ?

La recommandation de coucher le nourrisson sur le dos pour éviter le risque de mort subite a contribué au développement de la plagiocéphalie et de la brachycéphalie. Par conséquent, dormir en position couchée est la principale cause de ces difformités, mais pas la seule.

Graphique. Données obtenues par le service de neurochirurgie de l’hôpital de Sant Joan de Déu de Barcelone entre 1996 et 2010. Une augmentation de l’incidence des plagiocéphalies positionnelles est clairement observée. Données obtenues de: Plagiocéphalie positionnelle: une tâche de Primaire. (Année de publication: 2012)

Un peu d'histoire...

En 1994, l’AAP (American Academy of Pediatrics) a lancé aux États-Unis une campagne intitulée “Back to sleep”, qui a eu un grand impact médiatique. Cette campagne visait à promouvoir la recommandation de coucher les bébés en position couchée (sur le dos), car la communauté médicale internationale soupçonnait que le fait de dormir sur le ventre était un facteur de risque impliqué dans le syndrome de mort subite du nourrisson (SMSN). Au cours des années suivantes, de nombreux pays ont rejoint cette recommandation et ont lancé des campagnes dans le même sens. Moins d’une décennie plus tard, les résultats obtenus étaient incontestables : la mortalité due à la mort subite avait été réduite jusqu’à 50 %. Cependant, et parallèlement à ce résultat, l’incidence des malformations crâniennes n’a cessé de croître depuis le lancement de la campagne.

autres facteurs de risque

Dormir en position couchée (sur le dos) est la cause principale, mais ce n’est pas la seule. L’apparition de ces difformités a été liée à des facteurs qui influencent avant, pendant et après l’accouchement.

Dans certains cas, un aplatissement crânien peut commencer à se développer à l’intérieur de l’utérus. Il a été observé que, par exemple, lors de grossesses multiples, les bébés sont plus susceptibles de développer une plagiocéphalie positionnelle. Par conséquent, un environnement intra-utérin restrictif (peu d’espace), qu’il soit dû à une grossesse multiple, à un grand fœtus (macrosome), à une lactation prolongée, à des tumeurs utérines ou à un petit bassin, est l’un des principaux facteurs de risque. D’autre part, dans de nombreux cas, la racine du problème est la déformation subie par le crâne du bébé à la naissance. Cette déformation est considérée comme normale et dans de nombreux cas, les bébés se rétablissent en quelques semaines, mais dans certains cas, la déformation persiste, laissant certains os de la partie inférieure du crâne déséquilibrés. Cette dislocation des sutures aggrave la déformation, car le bébé passe la plupart de son temps couché pendant les premiers mois de sa vie.

It has been observed that boys are more likely to develop a positional head deformity. This may be because boys are usually larger, and one of the risk factors is the size of the foetus. The larger the foetus, the greater the risk of developing a head deformity due to the possible lack of space within the uterus and difficulty in fitting into the pelvic canal. Additionally, the baby’s head is also proportionally larger, and therefore the skull is heavier. The larger and heavier the head, the more pressure is produced on the head when the baby is lying down and therefore there is more risk of flattening.

Because of the torticollis, the baby tends to lean its head always to the same side, which can lead to a positional plagiocephaly. Studies have found that up to 90% of babies with plagiocephaly have torticollis at the same time, but only about 20% have been diagnosed or treated for torticollis before. This suggests that the real incidence of this pathology in newborn babies is much higher. Therefore, it is necessary to diagnose torticollis as soon as possible in order to start treatment and prevent the possible appearance of plagiocephaly.

Another risk factor is spending too many hours lying on devices such as hammocks, prams, etc. or not spending enough time practicing Tummy Time. Tummy time is a method of physical activity for newborns and infants that contributes to better development of motor skills. Practice it only when the child is awake.

 

Bottle-fed babies are more likely to develop plagiocephaly. This is not because of the diet itself, but because parents do not think about alternating the position, so they always place the baby on the arm that is most comfortable for them.

Premature babies are more at risk of developing a skull deformity because they often spend many hours in the Intensive Care Unit (ICU) and the bones of the skull are especially fragile and less resistant to external forces. Scaphocephaly has been found to be more common in premature babies.

WHAT ARE THEY

Positional cranial deformities are alterations in the shape of the baby’s head that appear during the first months of life, when the skull is especially soft and fragile.

As the baby’s brain grows, the cranial bones gradually expand to provide adequate space. If an external force (for example, a flat surface such as a crib) limits this expansion in a particular area, growth will be compromised in this area.

They are classified according to the area of the skull affected, although combined forms may also occur.

The most frequent form is plagiocephaly, which accounts for up to 85% of cases.

WHY DO THEY APPEAR?

The recommendation of sleeping on the back in order to reduce Sudden Infant Death Syndrome (SIDS) has contributed to the appearance of cases of plagiocephaly and brachycephaly, so sleeping on the back is the main cause of these deformities.

 

Chart. Data obtained by the Neurosurgery Service of the Hospital de Sant Joan de Déu de Barcelona between 1996 and 2010. An increase in the incidence of positional plagiocephalies is clearly observed. Data obtained from: Positional plagiocephaly: a task of Primary. (Year of publication: 2012)

A LITTLE BIT OF HISTORY...

In 1994, the AAP (American Academy of Paediatrics) launched a campaign called “Back to sleep” in the United States, which had a great media impact. This campaign was intended to promote the recommendation that babies should be put to sleep in the supine position (on their backs), since the international medical community suspected that sleeping in the prone (tummy) position was a risk factor involved in Sudden Infant Death Syndrome (SIDS). During the following years, many countries joined this recommendation and started campaigns in the same direction. Less than a decade later, the results obtained were unquestionable: mortality due to sudden death had been reduced by up to 50%. However, and parallel to this result, the incidence of cranial deformities has not stopped growing since the campaign was launched.

OTHER RISK FACTORS

Sleeping in the supine position (on the back) is the main cause, but it is not the only cause. The appearance of these deformities has been related to factors that influence before, during and after childbirth.

In some cases, cranial flattening may begin to develop inside the uterus. It has been observed that, for example, in multiple pregnancies, babies are more likely to develop positional plagiocephaly. Therefore, a restrictive intrauterine environment (little space), whether due to multiple pregnancy, large fetus (macrosoma), prolonged lactation, uterine tumours or small pelvis, is one of the main risk factors. On the other hand, the root of the problem in many cases is the deformation suffered by the baby’s skull during birth. This deformation is considered normal and in many cases babies recover in a few weeks, but in some cases the deformation persists, leaving some bones in the lower part of the skull unbalanced. This dislocation of the sutures makes the deformity worse, as the baby spends most of its time lying down during the first months of life.

It has been observed that boys are more likely to develop a positional head deformity. This may be because boys are usually larger, and one of the risk factors is the size of the foetus. The larger the foetus, the greater the risk of developing a head deformity due to the possible lack of space within the uterus and difficulty in fitting into the pelvic canal. Additionally, the baby’s head is also proportionally larger, and therefore the skull is heavier. The larger and heavier the head, the more pressure is produced on the head when the baby is lying down and therefore there is more risk of flattening.

Because of the torticollis, the baby tends to lean its head always to the same side, which can lead to a positional plagiocephaly. Studies have found that up to 90% of babies with plagiocephaly have torticollis at the same time, but only about 20% have been diagnosed or treated for torticollis before. This suggests that the real incidence of this pathology in newborn babies is much higher. Therefore, it is necessary to diagnose torticollis as soon as possible in order to start treatment and prevent the possible appearance of plagiocephaly.

Another risk factor is spending too many hours lying on devices such as hammocks, prams, etc. or not spending enough time practicing Tummy Time. Tummy time is a method of physical activity for newborns and infants that contributes to better development of motor skills. Practice it only when the child is awake.

 

Bottle-fed babies are more likely to develop plagiocephaly. This is not because of the diet itself, but because parents do not think about alternating the position, so they always place the baby on the arm that is most comfortable for them.

Premature babies are more at risk of developing a skull deformity because they often spend many hours in the Intensive Care Unit (ICU) and the bones of the skull are especially fragile and less resistant to external forces. Scaphocephaly has been found to be more common in premature babies.

WHat are they

Positional cranial deformities are alterations in the shape of the baby’s head that appear during the first months of life, when the skull is especially soft and fragile.

As the baby’s brain grows, the cranial bones gradually expand to provide adequate space. If an external force (for example, a flat surface such as a crib) limits this expansion in a particular area, growth will be compromised in this area.

They are classified according to the area of the skull affected, although combined forms may also occur.

The most frequent form is plagiocephaly, which accounts for up to 85% of cases.

WHY DO THEY APPEAR?

The recommendation of sleeping on the back in order to reduce Sudden Infant Death Syndrome (SIDS) has contributed to the appearance of cases of plagiocephaly and brachycephaly, so sleeping on the back is the main cause of these deformities.

Chart. Data obtained by the Neurosurgery Service of the Hospital de Sant Joan de Déu de Barcelona between 1996 and 2010. An increase in the incidence of positional plagiocephalies is clearly observed. Data obtained from: Positional plagiocephaly: a task of Primary. (Year of publication: 2012)

A LITTLE BIT OF HISTORY...

In 1994, the AAP (American Academy of Pediatrics) launched a campaign called “Back to sleep” in the United States, which had a great media impact. This campaign was intended to promote the recommendation that babies should be put to sleep in the supine position (on their backs), since the international medical community suspected that sleeping in the prone (tummy) position was a risk factor involved in Sudden Infant Death Syndrome (SIDS). During the following years, many countries joined this recommendation and started campaigns in the same direction. Less than a decade later, the results obtained were unquestionable: mortality due to sudden death had been reduced by up to 50%. However, and parallel to this result, the incidence of cranial deformities has not stopped growing since the campaign was launched.

OTHER RISK FACTORS

Sleeping in the supine position (on the back) is the main cause, but it is not the only cause. The appearance of these deformities has been related to factors that influence before, during and after childbirth.

In some cases, cranial flattening may begin to develop inside the uterus. It has been observed that, for example, in multiple pregnancies, babies are more likely to develop positional plagiocephaly. Therefore, a restrictive intrauterine environment (little space), whether due to multiple pregnancy, large fetus (macrosoma), prolonged lactation, uterine tumours or small pelvis, is one of the main risk factors. On the other hand, the root of the problem in many cases is the deformation suffered by the baby’s skull during birth. This deformation is considered normal and in many cases babies recover in a few weeks, but in some cases the deformation persists, leaving some bones in the lower part of the skull unbalanced. This dislocation of the sutures makes the deformity worse, as the baby spends most of its time lying down during the first months of life.

It has been observed that boys are more likely to develop a positional head deformity. This may be because boys are usually larger, and one of the risk factors is the size of the foetus. The larger the foetus, the greater the risk of developing a head deformity due to the possible lack of space within the uterus and difficulty in fitting into the pelvic canal. Additionally, the baby’s head is also proportionally larger, and therefore the skull is heavier. The larger and heavier the head, the more pressure is produced on the head when the baby is lying down and therefore there is more risk of flattening.

Because of the torticollis, the baby tends to lean its head always to the same side, which can lead to a positional plagiocephaly. Studies have found that up to 90% of babies with plagiocephaly have torticollis at the same time, but only about 20% have been diagnosed or treated for torticollis before. This suggests that the real incidence of this pathology in newborn babies is much higher. Therefore, it is necessary to diagnose torticollis as soon as possible in order to start treatment and prevent the possible appearance of plagiocephaly.

Another risk factor is spending too many hours lying on devices such as hammocks, prams, etc. or not spending enough time practicing Tummy Time. Tummy time is a method of physical activity for newborns and infants that contributes to better development of motor skills. Practice it only when the child is awake.

 

Bottle-fed babies are more likely to develop plagiocephaly. This is not because of the diet itself, but because parents do not think about alternating the position, so they always place the baby on the arm that is most comfortable for them.

Premature babies are more at risk of developing a skull deformity because they often spend many hours in the Intensive Care Unit (ICU) and the bones of the skull are especially fragile and less resistant to external forces. Scaphocephaly has been found to be more common in premature babies.