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Occipital flattening of positional origin: the increasingly common problem of occipital flattening among infants can be easily avoided by following a few simple guidelines

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Before 1999, occipital plagiocephaly (head flattening) of positional origin was rare. In 1999, Health Canada, the Canadian Paediatric Society, the Canadian Institute of Child Health and the Canadian Foundation for the Study of Infant Deaths released a joint statement, Reducing the Risk of Sudden Infant Death Syndrome (SIDS) in Canada. The statement recommended that all healthy infants be placed on their backs to sleep.(1) The implementation of these guidelines brought a dramatic drop in the SIDS rate in Canada(2) but also saw a concomitant increase in the occurrence of positional occipital flattening.(3) As a result, the four agencies released an update to the statement in 2001 intended to mitigate the occipital plagiocephaly resulting from placing infants on their backs to sleep.(4)

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The Children's Hospital of Eastern Ontario (CHEO) is a regional tertiary and community pediatric centre serving a population of two million. In 1994, CHEO had five referrals of infants presenting with occipital flattening. In 2002, we received over 300 referrals. We suspect that the prevalence in our region is much higher than the referral rate, although these statistics are not currently available. Fortunately, positional head flattening is largely preventable. The health care professional can assist new parents to avoid this problem.

PATHOPHYSIOLOGY

Occipital flattening of positional origin results when an infant spends prolonged periods with the head in the same position against a flat surface. This consistent pressure applied to one area deforms the skull.(5) Flattening may occur before birth as a result of prolonged wedging against a maternal pelvic bone,(6) or it may occur postnatally. Positional moulding of newborns' heads occurs early and quickly because newborns' soft cranial bones are very susceptible to pressure. Thus, occipital flattening is usually noticeable between two and four months of life. Once a flat...