Plagiocephaly: What It Is and Ways to Prevent It

Plagiocephaly may sound serious (and scary!) but it's nothing to be afraid of, and it's not all that uncommon. Plagiocephaly is the flattening of a baby's head. It's possible to do things to prevent your baby from developing plagiocephaly, and if your baby does end up with a flat spot, there are things you can do to correct it. Read on to find out more about plagiocephaly and other conditions that can affect your baby's head and neck.

15 What Is Plagiocephaly?

Simply put, plagiocephaly means the flattening of the skull. In Greek, plagio means slanted, and kephale means head. Babies are born with soft skulls made up of several bones (that haven't fused together yet) to allow them to pass through the birth canal during delivery. Because a baby's skull is so soft and moldable, their heads can sometimes come out long or even pointed after a vaginal delivery. It's actually kind of normal for a baby's head to be a bit misshapen during the first few days or weeks after birth. If the baby doesn't recover the normal shape of her head by around six weeks, or develops a flat spot, though, you might want to ask your doctor about the possibility of plagiocephaly.

14 What Causes Plagiocephaly?

Positional plagiocephaly usually occurs when a baby lies on his back or with his head to one side for an extended period of time. Babies that are really good sleepers (or that have really large heads) may develop plagiocephaly because they don't/can't move their head around much when they sleep. Babies that spend a lot of time on their back in swings and car seats can also develop plagiocephaly from being in one position for so long.

It's rare but sometimes babies can begin to develop plagiocephaly in the uterus. Babies that are born prematurely are sometimes more likely to develop plagiocephaly because their skull bones are softer than a full term baby's skull. Also, when there are multiple babies in the womb and babies have less room, they may be cramped in the uterus. If the mother has an unusually shaped uterus or fibroids in the uterus, these situations can also cramp the baby.

13 How Is Plagiocephaly Diagnosed?

To diagnose plagiocephaly, your pediatrician will examine your child's head. They will check for flat areas on the baby's head and evaluate the symmetry of your baby's facial features. You may be referred for x-rays or digital imaging as well. The doctor will also rule out other possible conditions.

12 Does Plagiocephaly Cause Any Medical Problems?

While it may cause visible flattening of the head, thankfully, plagiocephaly doesn't seem to be linked to any other serious medical conditions. Having a flattened head does not retard the growth of the brain or cause any developmental delays or brain damage. However, depending on the type or severity of the plagiocephaly, the asymmetry of your child's facial features could be visible and result in problems like jaw misalignment, dental issues, and finding eyeglasses or sports helmets that fit properly.

11 Why Has Plagiocephaly Become so Common?

You're probably well aware that when it comes to putting your baby down to sleep, "back is best." The American Academy of Pediatrics introduced the Back To Sleep campaign in the 90s, urging parents to always put babies to sleep on their backs. Although the AAP still recommends that babies sleep on their backs to prevent SIDS, the organization has recognized a connection between babies sleeping on their backs and developing plagiocephaly.

10 Will My Baby Need Surgery or Physical Therapy?

Most often, a pediatrician may recommend physical therapy or repositioning exercises to see if the problem will correct itself before suggesting a cranial orthotic or helmet. In the case of torticollis, where the neck muscles are short on one side and the baby's head and neck are twisted, physical therapy can improve muscle tone so that plagiocephaly gradually improves. If the baby doesn't respond to physical therapy, a helmet may be recommended. It's also very unlikely that your baby will need surgery, although it could be a possibility if your baby has craniosynostosis rather than plagiocephaly.

Keep reading for more information on torticollis and craniosynostosis.

9 Reposition Baby During Sleep

There are lots of things that you can do to prevent plagiocephaly and to improve the flattening of your baby's head. Putting your baby to sleep on his back is still important but change the way you place him in the crib. One night, put his head one way; the next night, place him in the crib so that his head is down at the other end. You want to encourage your baby to look in different directions as he's lying down in the crib. Or even as you're holding him, give him a different perspective by alternating where he sleeps in the crib (or how you hold him in your arms.) If the flat spot is caused mostly by your baby turning his head to look in the same direction all the time, this will hopefully help even it out.

8 Alternate Sides

If you breastfeed, you already alternate sides every time you nurse. You should keep up this practice even if you (or your partner!) bottle feed. Doing so will change how you cradle and hold the baby so his neck won't always be leaning in the same position. This is also important to make sure that his eyes develop equally.

7 Carry Your Baby More

It is important to reduce the amount of time your baby spends on his back or in a position where his head is resting on a flat surface. If your baby falls asleep in a car seat or swing, you may be tempted to leave him alone, but move him to the crib so that he has more room to move around in his sleep. Pick up and cuddle your baby often, which will take pressure off of your baby's head.  You can also hold your baby facing outwards to stretch your baby's neck, like this mom was told to do.

6 Limit Container Time

Car seats and swings may help your little one get to sleep, but again, if your baby spends too much time snoozing in their swing, they may end up developing a flat spot. You may think that moving your baby from the car seat to the swing to the crib is helpful but really, you're just shuffling your baby around from one container to the next, which can possibly lead to other problems.

There are also concerns that babies who spend too much time immobilized in these containers end up with developmental delays, movement disorders, behavior disorders, and other problems. Be sure to limit container time.

5 Tummy Time Is Important

Tummy time is extremely important when it comes to developing your baby's neck strength. It also gives your baby time to play in a position other than his back, which will relieve the pressure on his head and help to correct the flat spot.

It helps to introduce tummy time as early as possible. You can begin by placing your newborn tummy down on your chest or even across your lap for a minute or two at a time. You want to make sure that your baby is comfortable, so make sure he is on a soft surface (that's why tummy time cuddling on you is so great!) like a blanket or mat. You can even position a nursing pillow under his arms to encourage him to lift his chest and neck up.

You also want to make tummy time fun and stimulating for your baby. Get down on the floor with him, move around, and encourage him to look at you from different angles. Shake rattles and toys in different positions to get his attention and get him to turn his neck. Babies also love looking at themselves in mirrors, too!

Some babies are uncomfortable with tummy time but you have to stick with it. Start with small increments and work your way up to longer periods of time. Some parents do a few minutes of tummy time after every diaper change. Every little bit helps!

4 Orthotic Therapy

If your pediatrician suggests helmet therapy for your child, he will probably refer you to a certified orthotist to have a helmet custom-made.

First, your baby's head will be measured several times. Then, a cast will be made of your baby's head. A stocking-like cap will likely be placed over your baby's skull, and then several layers of plaster bandage will be draped over top. The plaster will harden and the cast will simply lift off of the baby's head. (No cutting is required to remove the cast.)  The cast is then used to custom-make the inside of the corrective band or helmet for your child.

You will have to schedule a return visit for a helmet fitting. The helmet will be placed on your child's head repeatedly, measurements will be taken, adjustments may be made, and you will be instructed on how to place the helmet on the baby's head and how to care for the helmet.

You will also probably have follow-up visits to check for changes to the shape of the skull and to make adjustments to the helmet as needed. Most babies will need to wear the helmet anywhere from 18-22 hours a day, every day, for 3-6 months.

3 Related: What Is Torticollis?

Torticollis and plagiocephaly sometimes go hand-in-hand. Torticollis is caused by damage to/shortening of a muscle in the baby’s neck. Congenital Muscular Torticollis can be caused by the baby's position and/or lack of space in the uterus, a traumatic delivery, or low levels of amniotic fluid. Some babies may be born with an actual tumor in the neck muscle, while other babies just have a tight or thick neck muscle, making it hard to move the neck. Torticollis can also occur in infants with weak muscle tone or that don't get enough exercise to stretch and work their neck muscles.

Plagiocephaly can occur in infants that have torticollis. Because they are unable to move their neck, infants often leave their head in one position, with the skull constantly putting pressure on the same spot.

Again, tummy time and limiting the use of containers is important in preventing torticollis.

2 Related: What Is Craniosynostosis?

Craniosynostosis is different from plagiocephaly. Craniosynostosis is a birth defect in which one or more of the joints between the soft bones of your baby's skull fuse together too soon before your baby's brain is fully formed. When this happens, the baby's brain can't grow in its natural shape, causing the head to become misshapen. Surgery is usually required to separate the fused bones, which will allow the brain to grow and develop properly.

Signs of craniosynostosis might not be visible at birth but may become more apparent during the baby's first few months. There are multiple forms of craniosynostosis, depending on what joints of the skull have fused together. The first symptom of craniosynostosis includes a misshapen skull, with the shape depending on which of the cranial sutures are affected. (When examining a baby for plagiocephaly, doctors will rule this condition out.) Other symptoms include slow growth of the head as the baby grows, development of a raised, hard ridge along the joints that are affected, and a disappearing "soft spot" on the baby's head.

If surgery is required, there are many different surgical techniques and procedures that can be chosen to repair the skull and provide your child with the best possible outcome.

1 Questions to Ask Your Pediatrician

If your baby is diagnosed with plagiocephaly, here are some questions you can ask to find out more information:

  • How did you come up with this diagnosis?
  • Is there a possibility this could be any other condition, or are there any additional conditions I should be aware of?
  • What most likely caused the flattening, and do you have any suggestions for how to remedy the flattening?
  • What treatments do you suggest at this time? Changes in sleeping position, exercises or physical therapy, a helmet? If we go ahead with any of these methods, when will you reevaluate and, if necessary, suggest we try something else?
  • What other resources would you suggest so I can be well informed about my child's condition?





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