Plagiocephaly

What is plagiocephaly?

Plagiocephaly is a condition where your baby’s head has a flat spot or is misshapen. There are various levels of severity and can occur during pregnancy or after birth.

There are two main types of plagiocephaly. Positional plagiocephaly, or “flat head syndrome,” is more common. It occurs in about 50% of children. Congenital plagiocephaly, or craniosynostosis, is a rare birth defect.

Symptoms of plagiocephaly

Doctors diagnose plagiocephaly in babies. Signs of the condition vary based on type and level of severity. Your doctor can help identify your baby’s symptoms, which include:

• Flattened area on back, side, or front of head
• Lack of hair in one spot
• Appearance of misshaped or slanted head
• Uneven ears (one ear pushed forward or up on the head)

Serious symptoms include:

• Lack of soft spot on your baby’s head
• Ridges or hard edges along skull
• Uneven facial features or other facial defects
• Lack of growth of your infant’s head size
• Seizures

What causes plagiocephaly?

Positional plagiocephaly can occur one of two ways. It has become more widespread since the mid-1990s when the National Institutes of Health launched the Back to Sleep campaign. Now known as Safe to Sleep®, the campaign’s goal is to reduce the risk of sudden infant death syndrome (SIDS). The main guideline is for babies to be on their back when sleeping. Sleeping or lying in the same position can produce a flat spot. Premature babies, who have softer skulls, or infants who are hospitalized for a prolonged time are more vulnerable. While placing your baby on their back may lead to plagiocephaly, it is still the safest position to place them in for sleep.

Babies also can be born with a flattened head due to pressure in the womb. This is more common in multiple births.

Congenital plagiocephaly, or craniosynostosis, is a birth defect. When your baby is born, the seams (sutures) on their head should be open and soft. This allows their skull to continue growing and reshaping in their first few years. With craniosynostosis, one or more of the seams close early, affecting the shape of your baby’s head.

How is plagiocephaly diagnosed?

A newborn baby’s skull is naturally soft and will continue to grow and reshape over time. As parents, you will be able to identify if your baby’s head is not growing or appears misshaped by regularly monitoring it. Your doctor also will measure your child’s head at their routine checkups.

Doctors recommend observing your baby’s head by looking directly down on it from above. If you detect a persistent flat area on your baby’s head, you can monitor the spot by taking photos. Contact your doctor if the spot shows no change or worsens.

Tests are not required to diagnose flat head syndrome. If your doctor suspects possible congenital plagiocephaly, they may order additional tests, such as an X-ray.

Can plagiocephaly be prevented or avoided?

There are things you can do to help prevent your baby from developing a flat head. Alternate your baby’s head position during sleep and have supervised tummy time when your baby is awake. You also can use a special mattress or pillow that puts less pressure on your baby’s head.

The cause of craniosynostosis is mostly unknown, and therefore is difficult to prevent. Recent studies by the Centers for Disease Control and Prevention report potential factors that can lead to craniosynostosis. These include thyroid disease, use of clomiphene citrate (a fertility medication), or certain genetic syndromes.

Plagiocephaly treatment

Based on the type and level of your baby’s condition, doctors may recommend one or more treatment options. You should begin treatment at a young age, between 3 and 18 months, while the skull is still forming.

Repositioning is a practice that teaches you how to regularly alternate your baby’s head position. This can prevent or help correct flat head syndrome. Suggestions for this method include:

• Plan plenty of tummy time, which also helps strengthen their neck.
• Reduce the amount of time your baby lies in a car seat, baby carrier, baby swing, etc.
• Rotate sides during feeding time, which also can help prevent torticollis (twisted neck muscles.)
• Put your baby in different positions in their crib. Your baby should lie on their back to reduce SIDS. However, you should rotate which direction your baby faces in their crib, such as away from or toward the door. You also can place a mobile above their crib to encourage head movement in different directions.

Another option is “helmet therapy.” Your baby will wear a medical helmet for several months to reshape their skull. The success rate for this form of treatment is high.

Babies who have congenital plagiocephaly, or craniosynostosis, often require surgery. This allows the plates on their head to grow and reshape, and also eases pressure on their brain. Typically, this type of surgery occurs prior to age 1. Use of a medical helmet may also be necessary. Additional medical treatments may be required if craniosynostosis is part of a genetic syndrome with other conditions.

Living with plagiocephaly

Babies who have flat head syndrome have a high chance of living a normal life. They can grow out of it naturally or correct it with therapy. It is unlikely to cause issues with their brain growth or function.

However, if plagiocephaly is left untreated, children are at risk of developmental, neurological, or psychological difficulties.

Children who grow up with severe plagiocephaly, like craniosynostosis, will likely require healthcare observation to manage ongoing or new problems. They also may benefit from counseling if they experience self-esteem issues.

Questions to ask your doctor

• How does a medical helmet work, and is it painful?
• Does insurance cover the cost of a medical helmet?
• Can flat head syndrome return again after treatment?
• How will I know if my baby’s flat head needs treatment?
• If one baby has plagiocephaly, are my other children likely to have it?

Resources

The National Association for Plagiocephaly