Plagiocephaly

Plagiocephaly, also known as deformational plagiocephaly or positional plagiocephaly, is a common and treatable condition that causes a baby’s soft skull to become flattened in one area due to continuous pressure on that part of the head.

Plagiocephaly can develop when a baby consistently sleeps in the same position. It’s often most noticeable during the first few months of life and usually peaks between 6 weeks and 3 months. Plagiocephaly tends to improve once babies gain strength and muscle maturity, tolerate longer stretches of tummy time, and achieve motor milestones such as rolling over belly to back and back to belly.

Typically, the only symptom of plagiocephaly is a flattened appearance of a baby’s head. It’s also not uncommon to notice a bump on the back of your baby’s head, asymmetrical ears, or an uneven forehead.

Plagiocephaly isn’t painful and doesn’t affect a baby’s day-to-day life or abilities.

Plagiocephaly is most often caused by a baby sleeping regularly in one position. Some studies show that 20 to 25 percent of infants who sleep on their backs develop some degree of plagiocephaly. Other causes of plagiocephaly include:

• Womb position: Babies who are part of a multiples birth, developed in a small uterus, or experienced low amniotic fluid may be at increased risk of plagiocephaly. Infants’ skulls often get misshapen from the birthing process, referred to as skull molding. This molding typically resolves quickly within the first week of life.
• Prematurity: Many premature infants spend extended periods in a fixed position while in the neonatal intensive care unit, which can lead to plagiocephaly. Some NICUs have started implementing cranial molding cups to help prevent plagiocephaly.
• Muscular torticollis: A shortening or tightening of the muscle in one side of the neck that causes the head to tilt in one direction.

In most cases, a clinician can diagnose plagiocephaly by examining your baby and reviewing their medical history. Testing is usually unnecessary.

Plagiocephaly is treated through non-surgical methods, including:

Positional changes

Changing your baby’s sleeping and resting positions can help reduce pressure on their skull, which is highly malleable during the first few months of life. Your doctor may recommend the following:

• Having your baby spend time on their tummy throughout the day
• Turning your baby’s head position during the night when sleeping on their back
• Eliminating swaddling during waking hours at around one month and entirely around three months
• Ensuring your baby doesn’t spend too much time lying down while awake

Exercises

Many infants with plagiocephaly — especially those born with an imbalance of the neck muscles, such as muscular torticollis — will benefit from exercises to increase neck range of motion. Sometimes, referral for an early intervention evaluation or to a pediatric physical therapist may be beneficial. These providers can teach you exercises and position changes to help with the torticollis.

The Perfect Noggin (specialized sleep surface)

The Perfect Noggin was developed by a plastic surgeon at Boston Children’s to reduce and prevent head-flattening in infants. The contoured surface of the Perfect Noggin aligns a baby’s head and torso in the best position for breathing, with a recess that cradles the back of their head to promote natural head shape and symmetry. This device is best implemented in early infancy before babies start to roll over.

Corrective helmet

Corrective helmets are most effective in infants from 4 to 8 months with moderate to severe head flattening. Corrective helmets must be prescribed by a licensed clinician, and carefully monitored and adjusted regularly. We help refer our patients to highly qualified orthotists who fit your child with helmets that can gently correct head shape as comfortably as possible.

Most babies need to wear the helmet 22 to 23 hours a day for an average of three months but potentially up to their first birthday to benefit most from the treatment. As your baby grows, their helmet will need periodic adjustments.

It’s also important to note that even with a helmet, your child’s head most likely won’t be perfectly round at the end of treatment.

The Plagiocephaly Clinic at Boston Children’s Hospital is at the forefront of diagnosing and treating plagiocephaly and other craniofacial conditions through our collaborative, multidisciplinary approach to care. We’re often able to diagnose some of these conditions before birth. This could mean referring an infant with plagiocephaly to a plastic and neurosurgery clinician to rule out craniosynostosis. Craniosynostosis is a condition where one or more of the skull bones fuse prematurely, resulting in an abnormal head shape that can resemble plagiocephaly. However, unlike plagiocephaly, craniosynostosis is treated surgically.