Flat heads

My eyeglasses sit lopsided on my face. I had always wondered why I had to kink one of the arms of my glasses so that the lenses could sit evenly across my nose. One of my ears was pierced twice, to correct a piercing mistake that was made since my ears don't line up. The first piercing was done with respect to the earlobe. Then the beautician noticed that the earrings, although aligned perfectly with each individual ear, weren't symmetrical with my face. 

It occurred to me in medical school during my pediatrics rotation that I must have an asymmetrical head shape, likely due to flattening of part of my head during infancy, otherwise known as plagiocephaly. This also made sense in the context of my birth history which included a tight cord around the neck and a forceps delivery. Sometimes these birth events result in muscle tension, spasm or bruising of infant neck muscles that limit head movements evenly from side to side (torticollis). This results in uneven pressure distribution to the infant's soft skull, resulting in a funny shape.

It is estimated that half of infants have some degree of plagiocephaly. This increase in positional plagiocephaly is due to the Back to Sleep campaign, launched by the American Academy of Pediatrics in 1992, which was responsible for greatly reducing the incidence of SIDS.

Given my personal interest in plagiocephaly, I have always been on the lookout for deformations in head shape. It is a cosmetic concern (it does not cause any problem with brain development), but one that can cause vision problems and/or self-esteem issues if the flattening is dramatic. When symptoms are mild to moderate in a child 6 months of age or younger, it can be treated with position changes, increased tummy time, and neck exercises if muscle tightening is a factor. When more severe, it can be treated with a referral to a specialist and a molded helmet.

Imagine my surprise when my baby was noted to have a slight flattening on the right side of his head at his one month check up! He had full range of motion of his neck muscles, he lifted his head well, he had plenty of tummy time (as much as a one month old can handle). I was placing him facing both ways in his bassinet. What was the cause of his clear preference to turn his head to the right?

It turns out, in thinking through my daily activities, that it was my right-handedness was creating his rightward head turn. I always held him with his head cradled on my left side (to leave my right hand free to do things). In order for him to look at me when I was holding him, he had to turn his head towards the right. This probably lead to a right-turning preference, if not the flattening itself. And this rightward turning preference during the day probably led to him sleeping with his head turned to the right more often at night, resulting in the flattening.