Positional Plagiocephaly

Plagiocephaly is a condition in which a baby’s head becomes misshapen (asymmetrical). Positional plagiocephaly is a type of this condition in which the side or back of a baby’s head has a flat spot.

Positional plagiocephaly is often related to the way a baby sleeps and plays. For example, babies who repeatedly sleep and play on their back may develop positional plagiocephaly from pressure to that area of the head. Positional plagiocephaly only affects how the baby’s head looks. It does not affect how the baby’s brain grows.

What are the causes?

This condition may be caused by:

• Pressure to one area of the skull. A baby’s skull is soft and can be easily molded by pressure that is repeatedly applied. The pressure may come from:
  • Your baby’s head being in the same position for sleep and play.
  • A hard object that presses against the skull, such as a crib frame.

What increases the risk?

The following factors may make your baby more likely to develop this condition:

• Being born early (prematurely).
• Being in the womb with one or more fetuses. Plagiocephaly is more likely to develop when there is less room available for a fetus to grow in the womb. The lack of space may result in the fetus’s head resting against his or her mother’s pelvic bones or a sibling’s bone.
• Having a muscle condition in which neck muscles are shorter on one side (torticollis). This may cause a baby to turn his or her head in one direction most of the time.
• Sleeping on his or her back.
• Being born with another defect or deformity.
• Having medical conditions that affect development and make it hard to change positions.

What are the signs or symptoms?

Symptoms of this condition include:

• Flattened area or areas on the head.
• Uneven, asymmetric shape of the head.
• One eye appearing to be higher than the other.
• One ear appearing to be higher or more forward than the other.
• A bald spot on the back of the head.
• The head bulging on one side.
• Uneven forehead.

How is this diagnosed?

This condition is usually diagnosed when your baby’s health care provider:

• Finds a flat spot or feels a hard, bony ridge on your baby’s skull.
• Measures your baby’s head and compares the placement of the baby’s eyes and ears.
• Does imaging tests, such as an X-ray, CT scan, or bone scan of the skull. These tests will show whether the bones in the skull have grown together.

How is this treated?

Treatment for this condition depends on the severity of the condition.

• Treatment for mild cases may include changing your baby’s positions for sleep and play. The safest way for your baby to sleep is on his or her back. For play, you may put your baby on his or her tummy, but only when he or she is fully supervised.
• Treatment for severe cases may include using a helmet or headband that slowly reshapes your baby’s head.
• Doing exercises or physical therapy to treat muscle and neck problems.

Follow these instructions at home:

• Follow instructions from your baby’s health care provider for positioning your baby for sleep and play.
• Take your baby out of car seats, carriers, and bouncers when he or she is awake.
• Carry your baby upright on your shoulder or in a front-positioned infant carrier or wrap. Adjust your baby’s head periodically so it turns both directions.
• Change sides when your baby is breastfeeding or bottle feeding. This will give your baby practice to turn his or her head in both directions.
• Only use a head-shaping helmet or band if prescribed by your baby’s health care provider. Use these devices exactly as told.
• Do physical therapy exercises exactly as told by your baby’s health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Summary

• Plagiocephaly is a condition in which a baby’s head becomes misshapen (asymmetrical).
• Positional plagiocephaly does not affect the way your brain grows.
• Treatment for this condition depends on the severity of the condition.