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What is plagiocephaly?

Plagiocephaly (sometimes called deformational plagiocephaly or positional plagiocephaly) is a very common, very treatable disorder. It causes a baby’s head to have a flattened appearance.

Plagiocephaly develops when an infant’s soft skull becomes flattened in one area, due to repeated pressure on one part of the head. Many babies develop plagiocephaly by sleeping regularly in one position. This condition occurs more often in premature infants whose skulls are especially pliable.

Treatment for plagiocephaly usually includes special exercises, varying sleep position or wearing corrective headbands or using molding cups.

Children with plagiocephaly often see a plastic surgeon or neurosurgeon to make sure they do not have craniosynostosis. Craniosynostosis is when the skull bones meld together and create an abnormal head shape that can look like plagiocephaly. However, unlike plagiocephaly, craniosynostosis requires surgery.

What are the symptoms of plagiocephaly?

Plagiocephaly causes a flattened appearance on one side of a baby’s head. This is typically the only symptom; it is not painful and does not affect the baby’s day-to-day life or abilities.

What are the causes of plagiocephaly?

Most babies develop plagiocephaly by sleeping regularly in one position. Studies show that 20 to 25 percent of infants who sleep on their back develop some degree of plagiocephaly. 

Other causes of plagiocephaly include:

  • Position in the womb. Because infants’ skulls are so soft, they are often a bit misshapen from the normal birthing process, but this does not cause plagiocephaly. Babies who are part of a multiple birth or who have a mother with a small uterus may be especially likely to have plagiocephaly.
  • Prematurity. Many premature babies spend extended periods of time in a fixed position while they recover in the neonatal intensive care unit. This often leads to plagiocephaly.
  • Muscular torticollis. This is a shortening of the muscle in one side of the neck, causing the head to tilt in one direction. 

How we care for plagiocephaly

Here at Boston Children’s Hospital, we have a long history of treating plagiocephaly and other types of brain and skull malformations that affect children. Experts in our Departments of Neurosurgery and Plastic Surgery work together to diagnose and treat children with plagiocephaly and other craniofacial anomalies. We are even able to diagnose some of these problems while babies are still in the womb.

Plagiocephaly | Diagnosis & Treatments

How is plagiocephaly diagnosed?

A trained clinician can usually diagnose the condition with a physical exam and medical history. In most cases, there is no need to order tests.

What are the treatment options for plagiocephaly?

Plagiocephaly is most often treated with one or more non-surgical methods.

Position changes

Changing your baby’s sleeping and resting positions can help your baby from increasing pressure on an already flattened area of the head. Your clinician may recommend:

  • having your baby spend some play time on his or her tummy
  • changing your baby’s head position when sleeping on his or her back
  • ensuring he or she doesn’t spend too much time lying down while awake 

Exercises

Many infants with plagiocephaly — especially those born with muscular torticollis, an imbalance of the neck muscles — will benefit from certain neck exercises. Your clinician may recommend a pediatric physical therapist to teach you these exercises.

The Plagio Cradle

The Plagio Cradle was developed at Boston Children's for use in infants age 3 months and younger. It is used to both reduce and prevent flattening in babies.

The Plagio Cradle is placed under a baby's head whenever he or she is lying on his or her back. It supports the neck and creates a hollowed space that gradually reshapes the baby’s head, allowing it to grow correctly over time.

Corrective helmet

Corrective helmets have been in use since 1979 to safely and successfully treat plagiocephaly. Helmets are most effective in infants from 4 to 8 months old who have moderate to severe flattening. The helmet is a lightweight plastic shell with a foam liner. It acts as a brace to redirect the growth of the baby's skull. Helmets must be prescribed and carefully monitored by a licensed clinician. As your baby grows, the helmet will need periodic adjustments.

A helmet does not squeeze the baby's skull, but gently helps correct the shape of the head by allowing growth in the flattened areas. To get the most benefit from the helmet, most babies need to wear it about 23 hours a day for about 3 to 6 months.

It's also important to note that very few people have perfectly round heads. Even when treated with a helmet, your child’s head probably won't be perfectly round.

Plagiocephaly | Frequently Asked Questions

Will my baby be OK?

Yes. Plagiocephaly is a very treatable condition that causes cosmetic changes in a baby’s skull shape. The condition responds extremely well to non-invasive treatments, like:

  • helmeting
  • molding cups
  • exercises
  • changes in sleep position

Is plagiocephaly common?

Yes. Plagiocephaly has become common since the American Academy of Pediatrics began advising parents to place infants to sleep on their backs to prevent sudden infant death syndrome (SIDS). Although this recommendation has increased the number of babies with plagiocephaly, it has also greatly reduced the number of babies lost to SIDS.

At what age does plagiocephaly develop?

Most parents notice the flattening of plagiocephaly when their babies are 6 to 8 weeks old.

Why does the flattening occur?

Flattening occurs when the infant’s growing head meets the resistance of a flat resting surface. It’s similar to how a pumpkin develops a flat spot in a field: Since it can’t grow into the ground, it conforms to the ground’s flat shape.

Why do only some infants develop plagiocephaly?

Any baby who has a limited ability to reposition his or her head can have this flattening. Babies who have other risk factors, such as muscular torticollis (an imbalance in the neck muscles), being part of a multiple birth, or having a mother with a small uterus may be more likely to have plagiocephaly.

When does the flattening process stop?

The flattening usually stops when babies gain head control, typically at around 3 months. A premature or delayed infant may have the flattening worsen for a longer time, since he or she may take longer to reach this milestone.

Can the flattening be prevented?

There are two main ways to help prevent flattening:

  • repositioning the baby often
  • changing the baby’s sleep surface from flat to concave

These strategies do not work with all babies and may not help to reverse any flattening that has already occurred.

Boston Children’s Hospital has developed a molding cup, called the Plagio Cradle, which can help reduce or prevent flattening in some babies.

Does plagiocephaly cause any medical problems?

No, there are no known medical problems linked to the condition.

What is the difference between plagiocephaly and craniosynostosis?

Craniosynostosis is the premature fusion of one or more of the joints that connect the bones in the skull. Unlike plagiocephaly, this condition may limit the size of the skull, increase pressure inside the skull, and damage brain growth. In plagiocephaly, there is no fusion of the skull joints.

Will my child need surgery?

No. Plagiocephaly is very treatable using non-surgical methods, such as special exercises, changes to sleep position, and corrective devices like helmets.

Will my child need physical therapy?

Physical therapy can be very helpful for some infants with plagiocephaly — especially those who are born with muscular torticollis, an imbalance of the muscles in the neck.

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Plagiocephaly | Programs & Services