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What is Positional Plagiocephaly?

By O. Wallace
Updated May 17, 2024
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Every parent wants his or her child to be healthy and perfect. Many parents are shocked to see their baby with a seemingly deformed or cone-shaped head immediately after birth, due to the squeeze through the birth canal. Fortunately, this type of deformation resolves itself within six weeks after birth. Positional plagiocephaly, also known as flattened head, occurs when a child’s head develops a flat area on one side or on the back of the head. The hair may be thinner on the flattened area, the ears may appear to be lopsided, and the forehead may bulge a little.

Although this sounds like a frightening diagnosis, positional plagiocephaly is not something to be too concerned about. The vast majority of babies with flattened heads end up with virtually perfectly shaped heads with the proper medical intervention, usually by the first birthday. Due to a child’s rapidly developing and growing brain, the bones of the skull must be soft and malleable. The soft nature of the skull allows it to mold against any harder surface, resulting in flat areas.

There are two types of positional plagiocephaly: positional brachycephaly, in which the back of the head is flat and the head is wide and short, and positional scaphocephaly, in which the head is narrow and long. The latter type is often the result of an infant being in the breech position in utero.

There are four major ways in which a baby develops positional plagiocephaly. The first occurs in utero and is called in utero constraint. The baby’s skull becomes flattened in one area due to pressure from the mother’s pelvis or ribs, or from other babies if there are multiple babies. The infant may be pressing against his or her sibling in their tight quarters.

The second way a baby develops positional plagiocephaly is prematurity. Preemies are often too fragile to hold or move around too much, so they lie in one position for long periods of times. In addition to this, their skulls are even softer than full term infants, making them even more susceptible to positional plagiocephaly.

Muscular torticollis is another cause of positional plagiocephaly. In these cases, an infant’s neck muscles are either underdeveloped or too short, resulting in the head turning to one side predominately. A baby with torticollis favors one side of the head over the other, resulting in flattened head because the head rests on one side. This type of positional plagiocephaly must be addressed by fixing the torticollis first, usually with physical therapy exercises.

The most common cause of positional plagiocephaly is the baby’s position while sleeping or resting. Swings, cribs, strollers, bouncers and playpens can all play a roll in positional plagiocephaly, and if a baby spends a great deal of time in any one of these without a change in position, the skull can become flattened. A rise in positional plagiocephaly is an unfortunate side effect of the American Academy of Pediatrics' 1992 campaign, Back to Sleep, which encouraged parents to place their babies on their backs to sleep in the hope of reducing sudden infant death syndrome (SIDS). While the campaign has been hugely successful, a study that took place from 1992 to 1994 showed that cases involving positional plagiocephaly increased six times, resulting in 33 cases out of every 10,000 infants. Since SIDS is a much greater concern than positional plagiocephaly, doctors continue to recommend back sleeping.

Your pediatrician may be able to assess and diagnose positional plagiocephaly without an x-ray, but an x-ray can rule out craniosynostosis, a more serious disorder in which the bones of the skull fuse together too early, resulting in an abnormal skull shape. If your doctor feels that the case of positional plagiocephaly is mild, he or she may recommend repositioning, a change of environment so the baby will focus in another direction, and more “tummy time.” Tummy time is imperative to a child’s development, both physically and mentally.

If your child’s positional plagiocephaly is more serious, a custom helmet or band may be prescribed. These are molded to fit your child’s specific needs and readjusted on a regular basis to encourage the skull to develop more properly. This type of treatment is most effective on four to six month olds. The soft pressure gently re-shapes your child’s head without invasive and difficult surgery. Surgery is a rarer treatment that may be performed to correct a particularly serious or stubborn case of positional plagiocephaly.

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