Positional plagiocephaly factsheet

Introduction

Plagiocephaly is a term used to describe a baby's uneven and/or asymmetrical head shape, which may also include the ears and face. It does not affect the development of your baby's brain. If it is not treated however, it may affect your baby's physical appearance by causing uneven growth of their face and head.

Signs and symptoms

Very flat on one area of the head (usually on one side of the back of the head)
One side of the forehead is further forward than the other
One ear is further forward than the other

Diagnosis

Your child’s doctor will be able to make a diagnosis, based on their signs and symptoms.

It is common for a newborn baby's head to be slightly uneven. This may be due to your baby's position in the womb, or due to moulding during the birthing process. By 6 weeks of age a baby's head should have remoulded to a normal shape and your baby should be turning their head both to the left and right.

An uneven head shape may occur in the first 6 - 8 weeks after birth if your baby has constant pressure on one part of their head. This may happen if your baby:

sleeps and plays in one position for long periods of time, usually on their back
always turns their head to one side only, when lying on their back

A "flat spot" at the back and/or side of the head can develop very quickly in a young baby. Once a flattened area has developed, it is easy for your baby to continue to rest on this flat area. This leads to further flattening and asymmetry.

Some babies are born with tight neck muscles, this is called torticollis. Torticollis stops babies from being able to turn their head fully to one side and can lead to positional plagiocephaly.

Treatment

Talk to your doctor about the best treatment for your child.

Your baby's head position needs to be varied during sleep, as well as during wake periods. This should be done from birth and is very important in the first six to eight weeks.

If you think your baby has torticollis, you should see your GP who may refer you to a physiotherapist. The physiotherapist can teach you exercises to do with your baby, to relieve the tightness in your baby’s neck muscles.

Management

Sleeping

Babies should sleep on their back to reduce the risk of SIDS. However you can vary the position of their head to prevent a flat area developing.

alternate turning of your baby's head to the left and right when you put them down to sleep
put your baby to sleep at alternate ends of the cot every other day till they are 6 months or start rolling around in their cot or
change the position of the cot in the room as babies tend to turn their head to look toward the centre of the room or doorway.

Playtime

When your baby is awake and supervised it is important for them to spend time in different positions. This gives them time off the back of their head and allows them to strengthen muscles needed for rolling, sitting and crawling.

tummy time should be started right from birth. Tummy time may be difficult to begin with but babies get stronger with practice and it will become easier for them around 3 months of age. Start by placing your baby on their tummy a few times a day for a few minutes when they are awake. Increase the time as they tolerate it better.
if your baby doesn’t like tummy time, other options include lying your baby facing your face on your chest, or placing a rolled towel under your baby's chest.
place toys on different sides of your baby or talk to them from different sides
if bottle feeding alternate how you hold the baby or the bottle to encourage baby looking alternate ways when feeding
vary the position you hold and carry your baby (e.g. using a carrier, holding upright, alternate over both shoulders, carry over your arm on their tummy or side)