Plagiocephaly (play-gee-oh-kef-a-lee) is a common craniofacial (skull and face) problem. Deformational plagiocephaly, also known as positional plagiocephaly, means a misshapen, flat or asymmetrical (uneven) head shape. Plagiocephaly does not usually affect the development of a baby's brain, but if left untreated, it may change their physical appearance by causing uneven growth of their face and head.
Plagiocephaly occurs because the bones of a newborn baby's head are thin and flexible, so the head is soft and may change shape easily. Flattening of the head in one area may happen if a baby lies with their head in the same position for a long time. When the head has a flat spot at the back of the skull, this is called brachycephaly (brak-ee-kef-a-lee).
There is another type of plagiocephaly caused by abnormal closure of the skull bones. This is called synostotic plagiocephaly and is not addressed in this blog post.
Signs and symptoms of plagiocephaly
It is quite common for a newborn baby to have an unusually shaped head. This can be either related to their position in the uterus during pregnancy or caused by moulding (changing shape) during labour, including changes caused by instruments used during delivery. Depending on the cause of the unusual shape, most babies' heads should go back to a normal shape within about six weeks after birth.
Sometimes a baby's head does not return to a normal shape, or they may have developed a flattened spot at the back or side of their head. Sometimes a flat spot develops when a baby has limited neck movement and prefers resting their head in one particular position.
How to prevent plagiocephaly
A baby's head position needs to be varied during sleep and when they are awake to avoid them developing deformational plagiocephaly.
Sleeping position: Your baby must always be placed on their back to sleep to reduce the risk of SIDS (Sudden Infant Death Syndrome or Cot Death). Do not use pillows in the cot for positioning.
A young baby will generally stay in the position they are placed for sleep until they can move themselves. Alternate your baby’s head position when they sleep. Place your baby at alternate ends of the cot to sleep, or change the position of the cot in the room. Babies often like to look at fixed objects like windows or wall murals, so changing their cot position will encourage them to look at things that interest them from different angles.
Playtime: When your baby is awake and alert, play or interact with them facing you (face time) or place them lying down on their front (tummy time) or on their side from as early as one or two weeks of age. Place rattles or toys (or other people’s faces) that your baby likes to look at in different positions to encourage your baby to turn their head both ways. Even at two weeks of age, your baby can follow your voice or eyes (maintain eye contact) and turn their head themselves each way if you support their head in your hands while they are awake and alert.
Vary your holding and carrying positions of your baby: Avoid having your baby lying down too much by varying their position throughout the day, e.g. use a sling, hold them upright for cuddles, carry them over your arm on their tummy or side.
When to see a doctor
If you have concerns about your baby's head shape or if you notice that your baby only turns their head to one side when lying on their back, see your Maternal and Child Health Nurse or GP.
Treatment for plagiocephaly
Most babies with deformational plagiocephaly do not need any treatment at all, especially if they are active and you have plenty of one-on-one interaction with them. Plagiocephaly usually improves naturally as your baby grows and gains head control and can move their head by themselves. The plagiocephaly will get better if you encourage your baby to turn their head themselves when they are awake. From the age of two weeks, while you are supporting their head in your hands, your baby can slowly follow your eyes or voice around, even if one way seems more challenging at first.
If treatment is necessary, you may be referred to a specialist clinic where your baby will be treated by a team that may include a paediatrician, plastic surgeon, physiotherapist and orthotist.
The most common treatment is provided by the physiotherapist, who will encourage active movement and teach parents how to position their baby and do exercises with them to help improve the head shape.
A very small number of babies with plagiocephaly (less than one in 10) have a severe and persistent deformity, and they may need to be treated with helmet therapy.
Key points to remember
- Lie your baby on their back for sleep, and do not use pillows in the cot.
- Vary the position of your baby’s head when putting them down to sleep, and your baby’s position when they are awake and alert. Give your baby face time and tummy time.
- Talk to your Maternal and Child Health Nurse or GP if you are worried about your baby's head shape.
- Plagiocephaly usually improves over time if your baby is active and has lots of one-on-one interaction.
- If helmet therapy is needed, it won’t hurt your baby, and the outcomes are normally very good.
For more information
See your GP or Maternal and Child Health Nurse.