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Plagiocephaly: What’s Its Effect on Breastfeeding?

Brown haired, brown eyed baby on a blanket

More and more infants and children are affected with plagiocephaly. There’s much that we don’t know about it. Maybe you’ve already wondered about the effect of plagiocephaly on breastfeeding. Or is there any effect at all?

Plagiocephaly can be defined as “a condition in which a baby’s skull is flattened on one side of the back or front of the head.” The condition can be present at birth, or it can develop during early infancy. It’s sometimes called “flat-head syndrome.” 

From our clinical experience and our understanding of anatomy, Dr. Andrew Dorough and I summarized what we believe to be the possible effect of plagiocephaly on breastfeeding.

Painful feeding for baby and/or mother

The human head is a little like a bowling ball. It should be round, and it should move easily and smoothly.

However, if the bowling ball or the infant’s head has a flat spot, movement would not be easy or smooth. Because of that, the baby may clench his jaw.

Subsequently, a baby might develop pain from the jaw-clenching, and also have neck pain from trying to compensate. Not surprisingly, the mother may have nipple tissue damage because the baby either cannot move his head with a smooth motion, and/or he has a jaw-clenching reflex.

Reluctance or refusal to latch

Sometimes, babies are hungry, but they are reluctant to latch, or just plain refuse to latch. This can happen in a variety of situations. But if plagiocephaly is the underlying cause, it may be that the baby simply can’t easily, smoothly latch onto the breast at a comfortable angle.

As the baby is trying to latch, think about what you see happening, and what’s going on within the baby. The only connection of the head to the spine is the occiput; a bone at the base of the skull. Then consider two nerves that pass through two openings:

  • The hypoglossal nerve passes through the hypoglossal canal.
  • The glossopharyngeal nerve (Cranial nerve XII) leaves the skull through the central part of the jugular foramen.  

Understanding the relationship of the bony structure and the nerves may suggest that there is an effect of plagiocephaly on breastfeeding.

While trying to latch, the baby needs to get positioned to do so, but pressure on those nerves could result in his reluctance or refusal to latch.

Milk is not being completely transferred

Sometimes, though, willingness to latch and vigorously approaching the breast doesn’t result in milk transfer in the baby with plagiocephaly.

First, infants with plagiocephaly often have facial asymmetry and jaw asymmetry. You can imagine that if there’s a mismatch of the sides of the face and/or jaw, there’s not complete closure of the mouth and hence, feeding is not completely effective. Milk dribbling out the side of the mouth during the feeding indicates an inadequate latch and can, and often does, occur in the infant affected with plagiocephaly.

Also, if the skull is somewhat flattened, as happens with plagiocephaly, there is abnormal pressure on the hypoglossal and genioglossal nerves. (Remember those two openings in the skull where the nerves pass through?)

As a result, you may see some sensory-motor issues, or notice substantial fasciculation (quivering) of the jaw or the tongue. Or, there may be some other abnormal motor function because of pressure on those nerves.

As you can see, I’ve said “may,” “might,” or “can” several times in this short post. Aside from clinical observations, we have very little evidence to confirm the effect of plagiocephaly on breastfeeding.

It may be many decades before we have any real evidence. But in the meanwhile, we can look at what we do know about plagiocephaly and its general effects.

As National Plagiocephaly & Torticollis Awareness Day approaches, you should know that plagiocephaly is much more than just a cosmetic problem. And, it doesn’t magically go away. Listen to my interview with Dr. Dorough to learn more.

Have you seen the examples above of the effect of plagiocephaly on breastfeeding? If you’ve breastfed a baby with plagiocephaly, what were your experiences? Share in the comments section below!

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  1. Lindsay Short

    Do you know if pediatricians allow for removal of helmets during feedings? Or are they advised to feed with the helmet in place?

    • Marie Biancuzzo

      Lindsay, good question. I honestly don’t know much about helmets. On the whole, the expectation is that the helmet be left in place with only a short break. On pediatricians, well, it’s not fair for me to generalize as to what one particular pediatrician would recommend or teach or expect. I think the bigger question is, what does the parent want, or what do they actually do? Here’s the thing. We “teach” or “tell” parents something. But in truth, parents are going to do whatever they want to do once they get home with the baby. (For the better, or the worse!) Moreover, I can tell you that if a physician tells me something to do for myself or my family, I need a very strong rationale for why I should do that. Some parents simply go home and do as they have been told. Others don’t. If you haven’t met those parents yet, I’m fairly sure you will meet them at some point!

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