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- Cleft Home
- What is Cleft Lip and/or Palate?
- Prenatal Diagnosis
- Feeding Your Baby
- What is a Cleft Team?
- Surgery
- Hearing, Speech, and Dental Care
- Paying for Treatment
- Managing Feelings
- Craniofacial Conditions
- Toddlers and Preschoolers
- The School-Aged Years
- The Teenage Years
- Letter to a Teacher
- Information for Adults
- Support Organizations
- Learn More: Downloads
What is positional plagiocephaly?
Positional plagiocephaly (also called flat head syndrome) is a condition characterized by a misshapen or asymmetrically shaped head. It is caused by excessive or constant pressure on the bones of the skull either before or after birth.
When babies are born, their heads are soft and malleable. This means their head shape can change, whether during gestation, during delivery, or after birth if a baby sleeps with their head turned consistently to the one side. As the baby’s skull bones join together (fuse), this flattened head shape can become permanent.
Who has an increased chance of developing positional plagiocephaly?
Several conditions can increase the chance that a baby will develop plagiocephaly:
- During a pregnancy with multiple fetuses (twins or triplets, for example), the fetuses may be too crowded to move about freely in the womb, causing pressure on their skulls.
- Babies born to women with unusually-shaped wombs or uterine fibroids may also have been crowded before birth, causing pressure on their skulls.
- Premature infants can develop plagiocephaly because their skull bones are softer than those of full-term babies and they cannot move their heads easily.
- Infants with torticollis (a condition that causes limited movement of the neck) often favor one side during sleep and may develop skull asymmetry.
- Babies with medical problems or delayed development can have difficulty moving from one position to another, increasing their chance for plagiocephaly.
Once born, all babies experience pressure on their skulls from such things as mattresses, baby carriers, and rocking chairs. Infants who cannot or do not move from one position to another may develop flattened skulls from this pressure. The flatness can occur directly across the back of the head, leading to a wide, flat head shape, or it can occur on one side, which causes asymmetry of the back of the skull and also the face.
Health care providers usually encourage caregivers to put babies to sleep on their backs to reduce the risk of SIDS (Sudden Infant Death Syndrome). When infants sleep on their backs and also spend many daytime hours on their backs or in firm baby carriers, they may experience pressure on the backs of their heads almost constantly. These babies may develop flattened heads.
What should I do if my baby has been diagnosed with this condition?
Babies who receive a diagnosis of positional plagiocephaly should be seen by a specialist. The specialist will need to rule out a condition called craniosynostosis, which is characterized by a baby’s skull bones joining together before the brain has fully formed.
What is the treatment for positional plagiocephaly?
When a baby with positional plagiocephaly is younger than six-months old, specialists typically advise caregivers to reposition their head frequently in order to keep the baby off the flat area. Caregivers can also help their babies develop neck strength by carrying them upright and by increasing “tummy time” by placing a baby on their stomach frequently during waking hours. Avoiding prolonged time in baby swings, rockers and car seats can help, as can using front-carriers or backpacks that do not place pressure on the baby’s head.
If your baby has torticollis, ask your doctor about exercises you can do with your infant. Your doctor may refer you to a physical therapist who can improve your baby’s ability to move their neck in all directions.
What are the treatment options if repositioning is not effective?
If repositioning alone is not effective, moderate or severe positional plagiocephaly can be treated with a helmet or band. These devices take advantage of a baby’s rapid head growth to change the shape of the skull, helping it to become more round. To be most effective, helmet or band use should begin when a baby is between four and seven months old. Helmets and bands do not put pressure on the head and are not harmful to a baby. They guide the ongoing head growth into the space within the helmet for the flattened portion of the head to gradually fill.
The overall treatment time for positional plagiocephaly varies depending on the severity of the plagiocephaly and the age of the child when they begin treatment. But specialists generally suggest that a baby wear a helmet or band for 23 hours a day for several months. Children undergoing these forms of treatment need frequent check-ups during the treatment period to adjust the helmet for ongoing growth.
Suppose my child is older than seven months old at the time of diagnosis?
Typically, the skull bones are most malleable before a baby reaches seven-months old, but helmet or band therapy can be started later in infancy. At an older age, the treatment may take longer and have more limited results. Treatment becomes ineffective as infants near their first birthday, when head growth slows significantly and children become able to remove the helmet themselves.
Will treatment for plagiocephaly increase my child’s risk of SIDS?
No. Wearing a helmet does not interfere with a baby’s breathing or sleeping.
Will plagiocephaly and its treatment damage my child’s brain?
No. There is no evidence that positional plagiocephaly or helmet or band treatment will damage a baby’s brain.
