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. It is a very common condition and resolves on its own.

It is caused by pressure on one side of the infant's head. This can occur due to factors such as:

Sleeping position: Infants who spend excessive time on their backs, especially without tummy time, are more prone to positional plagiocephaly.
Torticollis: A tightness in the neck muscles that stops babies from being able to turn their head fully to one side, leading to positional plagiocephaly.
Intrauterine positioning: Head moulding during pregnancy can contribute to plagiocephaly. It is common in twin and triplet births.

It is important to differentiate the condition from lambdoid craniosynostosis (premature fusion of the lambdoid suture). It can lead to serious complications if left untreated. Differentiating between these two conditions is crucial for ensuring appropriate management.

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 6-8 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.

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.

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.

In some cases, a computed tomography (CT) scan provides a cross-sectional view of the skull to visualise the sutures. This is the best way to tell if an unusual head shape is due to positional plagiocephaly or craniosynostosis.

Treatment

Positional plagiocephaly typically resolves on its own as the infant becomes more mobile and spends less time on their back. Simple measures, such as encouraging tummy time and varying sleeping positions can help facilitate normal head shape development.

A consultation with a physiotherapist is useful to ensure that there are no issues with neck movement. 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.

Helmet therapy for plagiocephaly is an option but not mandatory. It can be helpful in the right situation, but it's not always needed. The head shape does often get better, with or without the use of a helmet.

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

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)