Plagiocephaly

Many newborn babies appear to have an unusual head shape. This can be caused by the position of the baby in the womb during pregnancy or can happen during birth. Typically, a baby's head goes back to a normal shape within about six 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. Sometimes the baby’s face may appear fuller on the same side as the flat spot.  

Causes

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 their head in the same position for a long period of time. In 1992, the American Academy of Pediatrics began to recommend infants lie on their backs during sleep. The “Back to Sleep” campaign has successfully lowered the number of cases of SIDS (sudden infant death syndrome). However, since then pediatricians began to notice more and more babies with flat spots on the back of their head. 

It’s important to note that plagiocephaly is not caused by the joints that connect the bones of the baby’s skull (called sutures) closing too early. When one or more of these sutures close early, that condition is called craniosynostosis and it can also affect the shape of a child’s head.

Treatment

Many children with plagiocephaly do not require any treatment at all, since a child’s head shape can improve naturally as the child grows and begins to sit up. For children who do need treatment, the simplest and most inexpensive way to treat plagiocephaly is moving the baby off the flat side of their head. The positioning tips outlined below can help with this.

Occasionally, if the baby’s head shape does not improve by four to six months of age, a child may benefit from a custom-molded helmet. An appointment with our craniofacial surgeon will guide families in the best way to work with this issue.

Plagiocephaly care tips: Positioning adjustments

Some simple changes to how your child is positioned during their daily routines can help with plagiocephaly. A baby may be fussy with some of these changes at first.

• Alternate the side of the head your baby sleeps on. This is easier to do when the infant is young. Wedge pillows may help with positioning, but you need to check with your pediatrician before using a pillow in a baby’s crib. The American Association of Pediatrics does not routinely recommend the use of devices that restrict movement of the head.
• Move the crib so that your baby must turn their head off the flat side to look around the room. Babies will usually begin to recognize windows and bright contrasts as well as where the door is located. Alternating the wall that the crib is on can also help with this.
• When changing diapers, angle your baby on the side that isn’t flat and change the diaper in that position rather than with child lying flat on their back.
• When bottle or breastfeeding, position the child to keep them off the flat side.
• A neck support may be helpful in the car seat.
• In the car, place a suction toy or mirror opposite the flat side so your baby will want to look that way.
• When your baby is in the swing, bouncy seat, etc., angle the seat in a way that they need to turn their head to the fuller side to watch you or the activities going on around them.
• Provide supervised tummy time daily. This will promote normal shaping of the head and increase neck and upper body strength.