Plagiocephaly

Plagiocephaly refers to a misshapen head in infanthood. This is typically not something that a baby is born with, but develops in the early weeks of life. More specifically, plagiocephaly is when one side of the head becomes more flat than the other. If the back of the head is flatter than normal, it is brachycephaly.

It may coincide with torticollis, where muscles in one side of the neck are tight. This can limit movement, and encourage baby to keep their head turned to one side. As a result, the same side of their head is always in contact with the surface upon which they are laying.

Anatomy

The skull is made of a number of flat bones, and in adults they are strongly connected by joints known as sutures. Unlike ball-and-socket joints or hinge joints, these are not made for movement. Newborns have a lot of growing to do, so their skull bones are soft and the joints are made of cartilage.

Repeated pressure on one joint or bone will cause a change in shape.

Effects of Plagiocephaly

Plagiocephaly is not a painful condition, and in most cases there is no effect on the brain. The NHS recognises that very few children are teased at school due to their head shape- most cases improve on their own over time, and hair will disguise it to some degree.

Research is sparse, but some scientists link plagiocephaly to developmental delays. This study does not clearly identify whether the children in question also had craniosynostosis, which is a more serious cause of plagiocephaly.

Your osteopath will be looking for signs of craniosynostosis. Whereas plagiocephaly and brachycephaly are relatively benign and caused by positioning, craniosynostosis is a rare condition of the joints in the skull. Symptoms can initially be identical to those of plagiocephaly- the head may be asymmetrical or their forehead might be particularly prominent. In craniosynostosis, the joints of the skull fuse early. This is more evident when the baby is slightly older, as their soft spot may become solid before their first birthday. Not all cases need intervention, but more severe ones need to be referred on.

Treating Plagiocephaly

More severe cases are typically managed with a helmet. This is a tailor-made device that needs to be worn nearly 24 hours a day to reshape the head. In contrast, the most mild cases might be left to resolve themselves as the head grows and baby becomes more mobile.

It is important not to react to a diagnosis by sacrificing safe sleep. Current guidance is to put your baby to sleep on their back, as this position has the lowest association with infant mortality. Whereas a baby sleeping on their front is more likely to suffer SIDS, a flat head is not life-threatening.

Osteopathy can help if the root cause is tightness in the neck. Some babies are at higher risk of plagiocephaly because of a reluctance to lay on their front. This may be due to reflux, or sometimes a musculoskeletal issue, such as muscle tightness, that we can help with.

You can book an appointment in Naas with our paediatric osteopath here.

Reflux and Silent Reflux in Babies

New parents expect their baby to regurgitate a fair amount of their milk or formula in the early days. But there is a line between the normal spit-up and reflux.

What is Reflux?

Reflux in both adults and babies, is the return of stomach contents through the sphincter between the stomach and oesophagus (food pipe). Babies are particularly prone to this as their sphincter is less developed than that of an adult. This is why the vast majority of young babies spit up frequently- although this is typically outgrown relatively quickly. Babies with low muscle tone may be more predisposed to developing reflux. Reflux in adults is often associated with diaphragm dysfunction- osteopaths can help with this. Some babies may also have tightness in the diaphragm alongside their reflux.

There is a grey area between spit up and reflux. Generally speaking, if the baby is upset by their regurgitation, we need to start thinking about reflux.

When considering reflux, bear in mind that it is difficult to measure by eye the amount of fluid regurgitated. Try dropping a tablespoon of yogurt on a surface and you’ll see that it looks like a lot. You can gauge better the amount of food baby is taking on board by monitoring weight gain, and production of wet and dirty nappies.

Symptoms

The tissue that makes up the oesophagus is not equipped to deal with stomach acid. The alternative name we give it in adults (heartburn) describes the sensation well. Babies may not be able to communicate their discomfort in a particularly precise way, but there are a few clues.

During a feed, a baby with reflux may continually latch and unlatch. This may coincide with gulping air or burping. Alternatively, baby may cough a lot while feeding. Increased fussiness after feeding, especially if laid down soon after a meal, could also be a sign.

The textbook sign of infant reflux is the arching back (illustrated). Combine this with the other signs mentioned above and it should definitely be considered.

Silent Reflux

Silent reflux is so named because of its more subtle symptoms. Here, the stomach contents re-enters the oesophagus, but is not expelled from the body. It may not even reach the mouth, but that doesn’t mean it is not a problem. The irritation comes from stomach acid returning through the sphincter at the top of the stomach. Regardless of how much further it travels beyond this, the irritation has occurred.

When To Seek Help

Sometimes reflux can be a sign of something more serious. You should seek urgent medical attention if any of the following apply:

• there is blood in baby’s vomit or faeces

• baby is inconsolable

• baby can keep no fluids down at all

• their abdomen is distended or tender

• they have a fever alongside reflux symptoms

• their sick is yellow or green

You should also contact your doctor if baby’s weight gain is not as expected, or if symptoms persist after their first birthday. Symptoms typically resolve spontaneously in the first year of life.

To book an osteopathic appointment in Naas, click here.

Naas Osteopaths - Reflux and your baby

What is Reflux and should you be concerned?

Reflux is a common occurrence in baby’s and normally begins around 8 weeks of age and gradually improves as the baby gets older. Reflux occurs when some of the contents of the baby’s tummy return back up into their mouth. This usually occurs because the baby’s food pipe (oesophagus) is still growing and developing. The ring of muscle at the bottom of the oesophagus develops over time and this will prevent stomach foods from leaking out. It is a common and usually affects up to 40% of babies.

Signs and symptoms

Your baby may show no signs or they may show the following signs

- Regurgitating or spitting up milk during or after feeds.

- Refusing feeds, choking or gagging.

- Continuing hiccups or coughing.

- Excessive crying or crying while feeding.

- Repeated ear infections.

There is no real concern about reflux if your baby is feeding well, happy and gaining weight as normal.

Reflux - Osteopathy and your baby

When should i seek medical advice

Contact your GP, public health nurse or midwife if reflux starts after 6 months of age and continues beyond 1 year, or your baby has any of the following problems:

• Spitting up feeds frequently or refusing feeds.

• Coughing or gagging while feeding.

• Frequent projectile vomiting.

• Excessive irritability or crying.

• Green or yellow vomit

• Vomiting blood.

• Blood in their faeces or persistent diarrhoea.

• Swollen or tender tummy.

• High temperature (fever) of 38C (degrees Celsius) or above.

• Failure to gain much weight, or losing weight.

• Arching of their back during or after a feed, or drawing their legs up to their tummy after feeding.

Osteopathy For Your Baby

Whilst reflux can be a common problem for babies it can also prove to be a distressing time for both mother and child. A careful expert assessment can often find where troubles occur with feeding and offer advice on what can be done about it.

This can often be common sense advice or working in conjuction with other professionals like the lactation consultant and tongue tie specialists. Osteopathy may help the neck and diaphragm of baby relax, so that feeding time is more comfortable and efficient. The digestive system generally responds to soothing and relaxation , so that milk is naturally absorbed and processed.

A combined professional approach can often lead to a breakthrough for feeding comfort and success, allowing parents and baby to relax. To find out more information get in touch with us at Naas Osteopaths by emailing us at info@naasosteopaths.ie