Brachycephaly: Definition and management (What to do?)


Have you noticed that your baby's head is deformed and flattened backwards? You think of flat head syndrome or brachycephaly ? It probably is.

But rest assured, brachycephaly does not affect your baby's brain development. Nevertheless, this condition requires early management and specific therapeutic measures to prevent the aggravation of its unsightly appearance which could cause your baby to feel unwell.

By reading the following article, you will be able to define brachycephaly, know when and how to recognize its signs and find out how to cure it.

What is brachycephaly?

Etymologically speaking, the word brachycephaly » comes from the Greek « brachus » which means short and « kephale » which means skull. It defines a deformation or a flattening of the infant's cranial box known as the flat head syndrome.

The infant with this syndrome has a flattened head in its posterior part and enlarged laterally in its two parietal lobes.

Anatomically, brachycephaly results from a premature closure coronal (fronto-parietal) sutures accompanied by bilateral compensatory growth of the parietal sutures. Therefore, the back of the head is going to be higher than the forehead.

There is another type of cranial deformity called " plagiocephaly which also corresponds to a flattening of the head, but is distinguished from brachycephaly by its asymmetrical character.

What is the origin of brachycephaly?

In the vast majority of cases, brachycephaly is observed in syndromes associating cranial deformation with faciostenosis (facial deformation) such as: Apert syndrome, Crouzon's syndrome, Saethre-Chötzen, Pfeiffer, Muenke, etc.

In these syndromes, the deformation corresponds to mutations found in the genes: FGFR1, FGFR2, FGFR3, etc.

Besides these syndromes, there are other factors affecting the natural growth of the infant's head. The most frequently found factors are:  

  • Oligoamnios : which means insufficient liquid in which the future baby is bathed (lack of space).
  • Prenatal positioning defect : the case of dystocic presentations such as the "breech", sources of external pressure on the baby's skull, especially during its descent into the pelvic canal.
  • Sleeping on your back : as Baby's skull is very malleable in the first months of life, repeated sleeping on the back can cause the back of the skull to flatten.

 How to recognize brachycephaly?

As a general rule, when it comes to a malformation syndrome in an infant, only the doctor, general practitioner or pediatrician, is able to confirm or eliminate its existence.

But, since the diagnosis of brachycephaly is clinical and given the evidence of the deformity, even parents (if they are observant) can recognize its symptoms in the first 6 to 8 weeks of life.  

Theoretically, flat head syndrome can be recognized by the following symptoms:

  • Skull deformation: which is characterized by a flattening of the posterior part of the head, accompanied by a symmetrical widening of the parietal lobes. The back of the head is higher than the forehead.
  • A compensation bump at the forehead
  • A tension of the neck muscles under the effect of the weight, likely to cause a torticollis
  • Deformation of the orbits with, sometimes, a compensating look at sunset
  • A hydrocephalus, responsible for syndromeintracranial hypertension (HTIC)
  • Muscle weakness and stiffness.
  • Symptoms suggestive of crouzon's syndrome such as: exophthalmos, orbital hypertelorism, beak-shaped nose, jaw protrusion, etc.

These symptoms are usually sufficient to establish the diagnosis of brachycephaly. The use ofmedical imaging is rarely necessary unless the physician wants to rule out any brachycephaly-like abnormalities such as craniosynostosis.


Consequences of brachycephaly: an aesthetic and psychological impact 

Unlike plagiocephaly, apart from the aesthetic impact, no study has, to date, proven the link between brachycephaly and medical consequences of a psychomotor or functional nature.

This may be good news for parents but not for Baby! Certainly, the aesthetic impact is preferable to a delay in psychomotor development. But in the absence of psychological care, your child could have psychological problems and a lot of social difficulties later.

Treatment of brachycephaly 

The therapeutic approach to a case of brachycephaly consists, initially, in recommending a treatment based mainly on physiotherapy (physiotherapy) et osteopathy.

If there is little or no improvement after 3 to 4 months of physiotherapy or osteopathy, or if the infant is over 6 months old (the treatments are generally less effective), it is therefore advisable to take stock with his doctor to discuss a possible cranial remodeling by wearing a helmet.

Role of osteopathy in the treatment of brachycephaly

Osteopathy is one of the first solutions to think about to correct your child's cranial deformation. Despite the limited scientific evidence, it is a therapy that has proven its effectiveness in the curative treatment and in the prevention of brachycephaly.

To correct the deformity, the osteopath delicately exerts light painless pressure on the head so as to fix and balance the sutures in order to restore the symmetry and mobility of the head.

Regarding the number of sessions, this depends on the age and the importance of the deformation. Generally, the treatment includes between 3 and 5 consultations. But if it is a severe brachycephaly or brachycephaly in a baby over 3 months old, the osteopath will probably offer you a larger hourly volume (5 to 10 sessions).

Wearing a helmet

The helmet recommended for the treatment of flat head syndrome, has the main purpose of correcting deformities linked to brachycephaly and guiding the growth of Baby's head. It is a plastic cranial orthosis, hard on the outside and foam on the inside. This tool is designed to allow the growth of Baby's skull where there are no constraints.

The helmet should be worn 20 to 23 hours a day. Yes, Baby can sleep with it!

The duration of treatment can range from 4 to 8 months with follow-up requiring several follow-up appointments.

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