Positional plagiocephaly, or a flattened head, is common in babies due to the softness of their skulls. It can be caused by in utero binding, prematurity, muscle torticollis, and the position of the baby during sleep or rest. Mild cases can be treated with repositioning and tummy time, while more severe cases may require a custom helmet or headband. Surgery is a rarer treatment option.
Every parent wants their child to be healthy and perfect. Many parents are shocked to see their baby with an apparently deformed or cone-shaped head soon after birth, due to compression through the birth canal. Fortunately, this type of deformity resolves within six weeks of birth. Positional plagiocephaly, also known as a flattened head, occurs when a baby’s head develops a flat area on one side or the back of the head. The hair may be thinner in the flattened area, the ears may look lopsided, and the forehead may bulge slightly.
While it sounds like a scary diagnosis, positional plagiocephaly isn’t something to worry too much about. The vast majority of babies with flat heads end up with virtually perfect heads with the appropriate medical intervention, usually by their first birthday. Because of the rapid development and growth of a child’s brain, the bones of the skull need to be soft and malleable. The soft nature of the skull allows it to mold to any harder surface, resulting in flat areas.
There are two types of positional plagiocephaly: positional brachycephaly, in which the back of the head is flat and the head is wide and short, and positional scaphocephaly, in which the head is narrow and long. The latter type is often the result of an infant being breech in utero.
There are four main ways a child develops positional plagiocephaly. The first occurs in utero and is called in utero binding. The baby’s skull flattens in one area due to pressure from the pelvis or ribs of the mother or other babies if there are multiple babies. The child can press against the sibling in their confined spaces.
The second way a baby develops positional plagiocephaly is through prematurity. Preemies are often too frail to be held or to move around much, so they remain in one position for long periods of time. Additionally, their skulls are even softer than full-term infants, making them even more susceptible to positional plagiocephaly.
Muscle torticollis is another cause of positional plagiocephaly. In these cases, a child’s neck muscles are underdeveloped or too short, resulting in the head turning predominantly to one side. A child with torticollis favors one side of the head over the other, resulting in a flattened head because the head rests on one side. This type of positional plagiocephaly needs to be addressed by fixing the stiff neck first, usually with physical therapy exercises.
The most common cause of positional plagiocephaly is the position of the baby during sleep or rest. Swings, cribs, strollers, bouncers and playpens can all play a role in positional plagiocephaly, and if a baby spends a lot of time in one of these without changing position, the skull can flatten. An increase in positional plagiocephaly is an unfortunate side effect of the American Academy of Pediatrics’ 1992 Back to Sleep campaign, which encouraged parents to place their infants on their backs to sleep in hopes of reducing Sudden Infant Death Syndrome ( SIDS). Although the campaign was hugely successful, a study that took place from 1992 to 1994 showed that cases of positional plagiocephaly increased six-fold, resulting in 33 cases per 10,000 children. Because SIDS is a much greater concern than positional plagiocephaly, doctors continue to recommend getting back sleep.
Your pediatrician may be able to evaluate and diagnose positional plagiocephaly without an X-ray, but an X-ray can rule out craniosynostosis, a more serious disease in which the bones of the skull fuse together too soon, resulting in an abnormal shape of the skull. If your doctor thinks your case of positional plagiocephaly is mild, she may recommend repositioning, a change of environment so your baby focuses in another direction, and more “tummy time.” Tummy time is crucial to a baby’s development, both physically and mentally.
If your child’s positional plagiocephaly is more severe, a custom helmet or headband may be prescribed. These are shaped to fit your baby’s specific needs and readjusted regularly to encourage the skull to develop more properly. This type of treatment is most effective on babies aged four to six months. The gentle pressure gently reshapes your baby’s head without invasive and difficult surgery. Surgery is a rarer treatment that can be done to correct a particularly severe or stubborn case of positional plagiocephaly.
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