Plagiocephaly is an uneven or asymmetrical head shape, or a flattened spot on the back or side of a baby’s head. This change in head shape can happen because newborn skull bones are soft and moveable.

Causes of plagiocephaly

Newborn skull bones are soft, thin and flexible. This means that the heads of newborn babies can change shape easily.

Newborn babies often have strangely shaped heads. This can be caused by the head’s position in the uterus during pregnancy, or it can happen because of the squashy passage down the birth canal. It usually fixes itself within about six weeks.

Some babies might look like they have a flat head or a flattened spot on the back or side of their heads. This condition is known as deformational plagiocephaly. It might happen because babies lie with their heads in the same position for a long time.

Deformational plagiocephaly can be mild, moderate or severe. It can affect the shape of the head, the position of the ears, and the symmetry of the forehead.

In some babies, more severe deformational plagiocephaly can be caused by tight neck muscles
(congenital muscular torticollis), a strong preference for turning their heads to one side, or low muscle tone. Some babies with severe deformational plagiocephaly might also have a delay in the development of gross motor skills like rolling and crawling later in infancy.

Signs and symptoms of plagiocephaly

Your baby might have an uneven head shape, a flat head or flattened sections at the back or side of her head. Your baby’s ears might look uneven, and her forehead might be more prominent compared to the rest of her head.

When to see your doctor

See your General Practitioner (GP) or paediatrician if:

  • your baby has a strangely shaped head or a flat spot, which hasn’t gone back to a normal shape by about 2 months of age

  • your baby has a strong preference for turning her head to one side, or has difficulty turning her head

  • you’re concerned about your baby’s head shape.

The GP or paediatrician can refer you to the right specialist for targeted help, if needed. This might be a paediatric physiotherapist, or a plastic surgeon.

Treatment of plagiocephaly

Often, mild deformational plagiocephaly doesn’t need treatment. There’s good evidence that it will improve as your baby grows. It should fix itself by the time your child begins primary school.

This is because your baby’s head shape will naturally improve as her head grows and her gross motor skills develop. When your baby starts to spend less time on her back and more time on her tummy or sitting, there’ll be less pressure on the back of her head.

If your baby needs treatment, your doctor will refer you to a paediatric physiotherapist, paediatrician or a plastic surgeon, who’ll develop a treatment plan.

Treatment might include:

  • ‘counter-positioning’ measures – that is, positioning your baby so she avoids lying on the flat head spot when awake and supervised

  • gentle exercises and stretches to do with your baby to improve her neck movements

  • advice about how to carry your baby.

Physiotherapy and counter-positioning are likely to improve your baby’s plagiocephaly, especially when these treatments start as soon you notice your baby’s head shape.

For severe plagiocephaly, your specialist might recommend that your child wears a specially fitted helmet, which takes the pressure off the flat spot and allows your child’s head shape to improve as her head grows.

It won’t help to take your child to a chiropractor for back or neck adjustments. Research doesn’t support this as a treatment for babies with plagiocephaly.

Plagiocephaly prevention

There are several things you can do to help prevent your baby from developing deformational plagiocephaly:

  • Try to alternate your baby’s head position between right and left when he’s sleeping on his back.

  • When using the change table or cot, alternate the end at which you place your baby’s head.

  • When your baby is awake, put her on her tummy or side during supervised play. If your baby doesn’t want to do tummy time, start with 1-2 minutes and gradually increase as much as possible, with a goal of 30 minutes per day.

  • Stimulate your baby – for example, talk, sing or shake a rattle – or put toys near your baby on the side he likes least. This will encourage him to turn his head to that side.

If your baby has tight neck muscles (congenital muscular torticollis), it’s a good idea to ask your GP about seeing a paediatric physiotherapist for gentle neck stretching exercises.

Sleeping baby on her back is the safest sleeping position. Putting your child to sleep on her stomach or side increases the risk of sudden unexpected death in infancy (SUDI) including Sudden Infant Death Syndrome (SIDS) and fatal sleeping accidents.

© raisingchildren.net.au, translated and adapted with permission

Explore more