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Positional Plagiocephaly

Many newborn babies appear to have an unusual head shape. This can be caused by the position of the baby in the uterus during pregnancy, or can happen during birth. Typically, a baby's head goes back to a normal shape within about 6 weeks after birth.

Sometimes a baby's head does not return to a normal shape and the baby develops a flattened spot at the back or side of the head. This condition is called deformational or positional plagiocephaly.  It is the most common reason for a baby to have an unusual head shape.  

illustration of normal head shape and positional plagiocephaly

The bones of a newborn baby's head are thin and soft, so the head may change shape easily. Flattening of the head in one area may happen if a baby lies with its head in the same position for a long time.  It is not caused by premature fusion of a skull suture.  When one or more of the skull sutures fuse early, that condition is called craniosynostosis

In 1992, the American Academy of Pediatrics began to recommend infants lay on their backs during sleep.  The “Back to Sleep” campaign has successfully lowered the incidence of SIDS (Sudden Infant Death Syndrome).   However, pediatricians began to notice more and more babies with flat spots on the back of their head.  Sometimes the baby’s face may appear fuller on the same side as the flat spot. 

Treatment of Plagiocephaly

Many children with deformational plagiocephaly do not require any treatment at all, since the condition can improve naturally as the child grows and begins to sit up. For children who do require treatment, the simplest and most inexpensive way to treat positional plagiocephaly is maneuvering the baby off that side of the head.  Realize that the baby may be fussy with these changes at first.

  1. Alternate sides of the head that the baby sleeps on. This is easier to do when the infant is young.  Wedge pillows may help with positioning, but you must check with your pediatrician prior to using such a device.  The American Association of Pediatrics does not routinely recommend the use of devices that restrict movement of the head.
  1. Move the baby’s crib so that he/she must turn her head off the flat side. Babies will usually begin to recognize windows, bright contrasts as well as where the door is located.  Alternate the wall that the crib is on.
  1. Change diapers off to the fuller side and not straight in front of them.
  1. Place all toys on the opposite side of stroller, swing, crib and infant seat from the flat one.
  1. Alternate the hip which you carry them on to encourage him/her to look both ways.
  1. Bottle or breast feed to keep off the flat side.
  1. A neck support may be helpful in the car seat.
  1. Place a suction toy to the place in the car or mirror so that baby will preferentially look that way.
  1. When the baby is in the swing, bouncy seat or car seat in the home, place them at a 90 degree angle to you so that he/she is forced to watch you or the activities of the home with his head turned to the fuller side.
  1. Supervised tummy time.  This will promote normal shaping of the head and increase neck and upper body strength

If the baby’s head shape does not improved by the age of 6 months, you may want to contact your pediatrician. Some child with severe positional plagiocephaly may benefit from a custom molded helmet.  They work by applying gentle pressure on the skull and redirecting to the flatter side. This treatment can take two to five months with frequent office visits and requires a prescription from a physician.  Insurance rarely pays for helmet treatment even though the physician and the orthotist (the specialist who makes the helmet) work hard for insurance coverage .