Plagiocephaly in Infants

Causes and Treatments for Flat-Head Syndrome

Feb 15, 2008

What is Plagiocephaly?

Plagiocephaly, also sometimes referred to a “flat head syndrome”, occurs when a portion of an infant’s skull becomes flattened due to pressure from outside forces. There are different forms of plagio, including bracycehphaly (where the skull is flattened uniformly across the back, resulting in a shorter, wider head, and scaphocehpaly (where the skull is flattened on the sides, causing a longer, narrower head).

What Causes Plagiocephaly?

Plagiocephaly is caused by extended periods of pressure against one side or portion of the skull. This can happen in the womb, or because the muscles in one side of the neck are tighter than the other (a condition called torticollis that may require physical therapy to correct), or simply due to an infant’s having a preference for turning his head to one side.

Twins are at higher risk for plagio than singletons due to crowded womb conditions. Preemies may also be at higher risk because their underdeveloped skulls are so soft. They also trade time floating in amniotic fluid for long periods of time lying in incubators, increasing their risk.

What are the Dangers of Plagiocephaly?

Untreated, plagiocephaly can lead to permanent deformation of the skull. If severe enough, this type of deformation can impact facial asymmetry, and can lead to problems including TMJ, speech and vision issues. Perhaps most devastating are the self-esteem issues that may arise when a child has an unusual facial or head shape.

How Can Plagiocephaly be Prevented?

Avoid having your baby lie on his or her back for long periods of time. Extended time in carriers, swings, or bouncy seats can increase a child’s risk. Offer lots of tummy time, which not only takes the pressure off the skull, but helps to strengthen neck muscles. Avoid always changing or holding your baby on the same side; alternating sides helps distribute pressure evenly.

How Can Plagiocephaly Be Treated?

First, share your concerns with your doctor. He or she will need to determine that the flatness is indeed plagiocephaly, as opposed to craniosyntosis, a much more serious condition that is caused by premature fusion of the cranial sutures and requires surgery to correct. Mild cases may be helped by intentional and consistent repositioning of the head.

Avoid having your baby lie on the flat part of his head: if necessary, switch the side he is changed on, held on, or the direction he sleeps. If repositioning does not work, physicians may recommend that the infant be fitted for a cranial orthotic, commonly known as banding or helmeting. Be sure to consult your doctor if you notice anything unusual about your babies’ head shape.

What Does a Helmet Do?

Each helmet is specially made for the infant by an orthotist. Cranial measurements are taken, and a helmet is built that will help to reshape the babies head over time. Space is built into the helmet around the “flat spot” to encourage growth in that area. Babies typically wear the helmet for several months, with frequent checkups to assess improvement. Typically, the best outcomes for helmeting occur when the therapy is started well before one year of age. After that time, a baby’s skull begins to harden, limiting the potential for shape correction.

For more resources and information, please visit the Plagiocephaly Information website, which served as the source for the medical information in this article. Please consult your doctor if you have any concerns about the shape of your baby’s head.

The copyright of the article Plagiocephaly in Infants in Infant & Toddler Health is owned by Susan Carney. Permission to republish Plagiocephaly in Infants in print or online must be granted by the author in writing.

Oct 23, 2008 1:01 PM

Guest :

My little boy Sam is 3 years 4 monthe. He was breach and and had plagiocephaly caused by a muscle in his neck not working correctly. He had a star band from 5 months until 14 months and his head is normal now. His speech is not coming on and he is under a speech therapy. He has only just started copying words and dosent really have a conversation with you. He also has a lazy eye, which you can only see when he looks up. Do you think this could have been caused by the plagiocephaly. Please advise thanks

Oct 24, 2008 10:45 AM

Susan Carney :

I really couldnt sday, as I am not a medical professional. If you have concerns about your son's development you should share them with his pediatrician. Good luck!

Nov 5, 2008 8:21 PM

Guest :

My son is 14 months old and has plagiocephaly and has been wearing a helmet since march. it may be just a coincidence but he is behind in speech. they told me they will only do speech therapy with 2years+. but they did suggest early intervention.

Feb 9, 2009 2:07 PM

Guest :

my sonis almost 7 months and he had the muscle stiff in his neck too. Me and my husband are hearing different things about the helmet. His physical therapist thinks that it will work to use a helmet while all the Dr in the Ped. clinic say that it won't. Does anyone have any advice they can give me cause I would love to hear from someone who has first hand experience with the helmet.

Mar 13, 2009 4:44 PM

Guest :

My little daughter is 6 months and 10 days, she has a mild plagiocephaly, I discovered her abnormal head shape when she was 3 months, so I started repositioniong, and she improved, but currently there is no improvement since she turns her head to the ftattened side when she is sleeping. the neurosurgeon said she has a mild plagiocephaly so she doesn't need a helmet, but I'm not convinced, I need a second opinion, should I ask the pediatrician to refer her to see a other neurosurgeon?

Apr 1, 2009 6:47 PM

Guest :

Our oldest son had plagiocephaly and one of the pediatricians at the practice we took him to said not to worry. Another had us make an appt w/a specialist who fitted jhim wit ha helmut. He was maybe 4-6 months old at the time and it was hard but worth it. He is almost 6 yrs old and we can't see any sign of flat spot or experienced any developmental issues. Our daughter was fine and now our youngets seems to be sleeping towards one side and we are concerned. if you are not at peace wit hthe advice a doctor is giving you, then by all means get a second opinion. The helmut worked great but again, a lot of work, especially for first time parents like we were. Good luck

Apr 26, 2009 6:46 PM

Guest :

I was wondering....what are these helmets made of? And, from the picture of the adorable little baby, I see you can get them with "personality."

Apr 27, 2009 4:09 AM

Susan Carney :

Ours was some sort of plastic composite with foam type padding on the inside. And yes you can get them in different patterns to suit your little ones' personality! :)

Sep 29, 2009 9:22 AM

Guest :

I have a 3 nearly 4 year old son ,his head is flat on one side and has been since birth ,i did take him to see our doc when he was a baby but was told his head would sort it's self out as he grow ,but today i went to collect him from nursery and a member of staff pulled me aside and asked me about my son's head shape and asked me to make an appointment with my doc to have his head checked .has anyone got any advice for me ?