Understanding Plagiocephaly
Understanding the causes, risk factors, treatment options, and the importance of early intervention for infant head shape abnormalities.
Affects an estimated 20–30% of infants to varying degreesQuick Answer
Plagiocephaly, also called flat head syndrome, is an asymmetrical flattening of a baby’s skull caused by sustained pressure on one area of the head, restricted neck movement, or the natural softness of newborn skull bones. It affects an estimated 20–30% of infants to varying degrees, and in mild to moderate cases it’s typically resolved through repositioning and tummy time; more persistent cases may require helmet therapy.
What Is Plagiocephaly?
Plagiocephaly, commonly known as flat head syndrome, refers to an asymmetrical distortion or flattening of a baby’s skull. It is estimated to impact approximately 20–30% of infants to varying degrees. This condition can arise from multiple factors, including sustained pressure on one area of the head, restricted neck movement, and the malleable nature of a newborn’s skull bones.
Causes & Contributing Factors
The causes of plagiocephaly are nuanced but generally stem from fixed or restricted positioning of the head during sleep and waking hours. For example, consistently resting an infant on their back can cause flattening of the rear skull. Prolonged time spent in car seats, strollers, swings, and other stationary containers may also contribute to plagiocephaly if pressure is placed on the same part of the head repeatedly.
Muscle tone and strength also play a significant role, especially in the neck. Infants with low muscle tone or minimal strength to lift and turn their heads are more susceptible to developing plagiocephaly. Prematurity, torticollis, and multiple births are other potential risk factors.
Impacts of Plagiocephaly
If left untreated, plagiocephaly can lead to both cosmetic and developmental issues. Visible skull and facial asymmetry may be present. In severe cases, plagiocephaly can cause compensatory cranial distortions, such as the forehead protruding on the flattened side.
Some studies also indicate that persistent plagiocephaly may impact early cognitive and motor development, although more research is needed in this area.[1] Early treatment is crucial for preventing cosmetic issues and ensuring infants meet physical and mental developmental milestones.
Treatment Options
To resolve plagiocephaly, healthcare providers typically suggest repositioning techniques to encourage full head movement throughout the day and supervised tummy time while awake to build neck strength. Alternating the baby’s direction in the crib at night is also recommended. In many cases, diligent repositioning and tummy time resolve mild to moderate skull flattening.
In persistent plagiocephaly cases, a molded helmet can be prescribed to gently reshape the skull over time. Helmet therapy is most effective in infants under 6 months old while the skull is still malleable. The helmet is worn 23 hours a day for several months and works by applying mild, constant pressure to protruding areas while leaving room for flattened regions to expand symmetrically.
Preventative Measures
Preventing plagiocephaly from developing is a proactive process starting right after birth. Parents and caregivers should aim to alternate their baby’s orientation frequently throughout the day during naps, feedings, playtime, and other activities.
Limiting prolonged time spent in car seats, carriers, swings, and other stationary containers is recommended whenever possible.
Additionally, supervised tummy time should be incorporated into each day, starting with just a few minutes at a time in newborns and building up as infants gain strength and motor control. Tummy time promotes muscular development and gives babies experience moving their heads in all directions, reducing positional flattening.
The Role of Healthcare Providers
Healthcare professionals are crucial in preventing, identifying, and treating plagiocephaly. Properly explaining infant positioning and tummy time guidelines empowers parents to reduce plagiocephaly risks proactively. Regular screening for skull asymmetry and other markers allows for early detection and intervention.
In cases where plagiocephaly is identified, providers guide families through appropriate treatment plans, which may include physical therapy, repositioning education, and referrals for helmet therapy evaluations.
“Your baby’s head shape can be scanned, captured, and tracked over several months to see if the baby is improving, staying the same, or getting worse.”
— Stuart Weiner, CPO, LPO, Director of Cranial Center
By staying up-to-date on plagiocephaly research and therapy options, healthcare teams can best serve patients and nurture optimal infant development.
Frequently Asked Questions
What causes plagiocephaly?
Plagiocephaly is generally caused by sustained pressure on one area of a baby’s skull — from sleep positioning, prolonged time in car seats or swings, low neck muscle tone, or the natural softness of a newborn’s skull bones. Prematurity, torticollis, and multiple births are additional risk factors.
How common is plagiocephaly?
Plagiocephaly is estimated to affect approximately 20–30% of infants to varying degrees.
Can plagiocephaly be treated without a helmet?
Yes. In many cases, mild to moderate plagiocephaly resolves with diligent repositioning techniques and supervised tummy time that encourage full head movement and build neck strength — without needing helmet therapy.
When is helmet therapy needed for plagiocephaly?
A molded helmet is typically recommended for more persistent cases. It’s most effective in infants under 6 months old, while the skull is still malleable, and is generally worn 23 hours a day for several months to gently reshape the skull.
Can plagiocephaly affect a baby’s development?
If left untreated, plagiocephaly can lead to cosmetic issues like visible skull and facial asymmetry. Some studies also suggest persistent plagiocephaly may affect early cognitive and motor development, though more research is needed — which is why early treatment is recommended.
How can plagiocephaly be prevented?
Frequently alternating a baby’s head orientation during naps, feedings, and playtime; limiting prolonged time in car seats, carriers, and swings; and incorporating daily supervised tummy time are the main preventative measures.
Sources: [1] American Academy of Pediatrics, “Prevention and Management of Positional Skull Deformities in Infants.”