Swedish Medical Info

Abstract from the Swedish Department of Health’s Guidelines for Newborn Babies

Translation from an information leaflet given to all new parents:

Sleeping on the back: research from a number of countries show that the risk of sudden infant death is reduced when the baby is put down to sleep on its back instead of the tummy. We advise you to let the baby sleep on its back from the start. One reason the back position is better can be that the upper parts of the respiratory passages are kept open more easily.

A soft pillow should be used when the baby is sleeping on its back to prevent the back of the head from flattening. Alternate the positioning of the baby’s head to the left and right. This way you prevent any pressure points from developing which causes the head to flatten or distort its shape.

Socialstyrelsen (the Swedish National Board of Health & Welfare)

Information Page Given to New Parents in Sweden:

Deformational plagiocephaly and brachycephaly

Deformational plagiocephaly (DP) is a condition in which the infant’s head is deformed as a result of prenatal or postnatal external moulding forces to the growing cranium. The natural history of DP is likely to have existed for centuries although at a lower rate than present.

The skull undergoes 85 % of its postnatal growth within the first year of life. The growth is most rapid during the first six months of life, especially the first three months; hence the plagiocephaly can develop very quickly in a newborn. The typical DP forms a parallelogram in addition to the usually unilateral flattening of the occipital area; there may be ipsilateral frontal and parietal bossing, cheekbone prominence and anterior ear displacement ipsilateral to the flattened occiput. Factors associated with increased risk for DP are congenital muscular torticollis, first-born birth rank, positional preference when sleeping, lack of tummy time when awake (min 3 times per day) resulting in slow achievement of motor milestones.

The typical infant with brachycephaly has a broad flattened head.

Despite the increase of deformational plagiocephaly and brachycephaly, the recommendation to use supine sleep position should be followed because the risk of sudden infant death (SIDS). Flattened head is preventable and parents should be instructed to put the infant down to sleep in the supine position, altering positions of the head (left and right occiput). The use of a soft baby pillow when the infant is in the supine position can reduce the moulding forces. When awake and supervised, the infant should spend a lot of time in the prone position (tummy time) already at early age i.e. as newborn (always without a baby pillow). The infant should spend minimal time in car seats (when not passenger in a vehicle) or other seating that maintains a supine position.

If the infant has developed an obvious asymmetry of the skull, consequent avoidance of pressure/lying on the flattened spot will reduce the asymmetry, and it can disappear totally if treated consequent and early.

Anna Ohman PhD
Paediatric Physiotherapist
The Queen Silvia Children’s Hospital
Sahlgrenska University Hospital
Gothenburg, Sweden

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