Plagiocephaly (sometimes called positional plagiocephaly) is a very common condition in infants that causes flattening of the skull in a specific area. It usually develops due to repeated pressure on one part of the head. Many children develop it from regularly sleeping in the same position.

This condition occurs especially often in premature infants, whose skulls are even more malleable and delicate. The good news is that it can be treated with timely precautions: here's how.

Plagiocephaly: what it is and what it entails

positional plagiocephaly is a common condition in which specific areas of a newborn's head develop an abnormal shape and flattened appearance. Specifically, occipital plagiocephaly causes flattening on one side of the back of the head and can occur when a baby lies on their back with their head turned to the same side most of the time.

Flattening of part of the skull can occur within a few months and may show up physically as one ear shifting forward, creating an asymmetrical appearance, or as a more pronounced forehead or jaw.

There are also other types of plagiocephaly caused by a serious condition called craniosynostosis , in which the deformity is caused by the premature fusion of the fibrous joints between the bones of the infant skull.

Plagiocephaly: possible causes

A small percentage of newborns are born with positional plagiocephaly due to twin or multiple pregnancies, which reduce space in the uterus, or due to premature birth. In these cases, there are no preventive measures that expectant mothers or healthcare providers can take to prevent a baby from being born with a flat head.

Infants' skulls, in fact, are very soft and malleable so they can adapt while passing through the birth canal during childbirth. This is why many newborns are born with slightly shifted or flattened skulls due to the pressure exerted during delivery.

Plagiocephaly: who makes the diagnosis and how?

The diagnosis is usually made by the pediatrician. During the first visit, they typically check whether the shape of the skull is symmetrically oval. If the doctor notices an asymmetrical shape, they may prescribe an X-ray of the skull or a CT scan, but only after checking for the absence of neck stiffness, such as torticollis, muscle shortening, or similar issues.

In this case, the specialist best suited to help may be a physiotherapist who specializes in neonatal treatments and can recommend stretching exercises to do with your baby.

Plagiocephaly: by when does it resolve?

Positional plagiocephaly usually resolves within six weeks after birth; however, some children prefer to sleep with their head turned to one side, perhaps due to shortening of the neck muscles, which prevents them from turning it to the opposite side.

Plagiocephaly: possible solutions

To reduce the risk of developing positional plagiocephaly, or to improve its effects, you can also adopt these simple measures.

• Position your baby in a prone position: while supervising, occasionally place your baby on their tummy. This helps strengthen the muscles of the neck, shoulders, and arms.

• Change the direction during sleep: to help ensure your baby doesn't always rest their head on the same side, alternate the direction you lay your baby in the crib each week.

• If your child is awake, do not leave them in the car seat, carrier, or infant seat for too long.

• Cuddle time in your arms: during the day, hold your baby often in your arms in an upright position, resting on your shoulder, and support their head, especially in the first few months of life.

• If your child already has plagiocephaly, even gently, when you hold them in your arms, breastfeed them, or transport them in the car seat, ensure there is no excessive pressure on the flat side of the head. Change your child's position from one side to the other during feeding.

• If your baby is in a cradle or car seat, frequently move them around the room so they always have new stimuli to seek out and look at.

• If your child shows neck stiffness, it will be necessary to consult the pediatrician to relieve muscle pain and allow your little one to turn their head freely to one side or the other.

Plagiocephaly: possible treatment options

In most cases, having a flat head will not affect proper brain growth or a child's mental development. Once your little one is able to sit up and then stand, the pressure on the skull caused by lying down decreases significantly, and the deformity begins to improve. Even if it does not completely resolve, any remaining flattening is usually milder and, once covered with hair, is no longer noticeable.

Mild deformities in the frontal area tend to resolve completely over time. With the help of the pediatrician, the situation will be monitored in case the child develops problems with chewing or vision.

Plagiocephaly: does the helmet really help?

Here's how a possible scenario could unfold:

1. The pediatrician makes the initial diagnosis and usually recommends a course of positional therapy.

2. If this does not resolve the problem, parents will be referred to a specialist, such as a pediatric neurosurgeon, who, after reviewing the child's clinical history, may consider prescribing a cranial remolding helmet if plagiocephaly is moderate or severe.

3. In that case, the family will then be referred to an orthoptist for helmet fitting. The orthopedist may choose to take clinical photographs and perform a series of measurements with calipers or conduct a scan to assess the shape of the child's skull. These images and measurements serve as a reference point throughout the course of treatment. At this stage, the orthoptist will create a duplicate of the child's head, using a plaster impression or a 3D scan, to produce a custom helmet.

The helmet will need to be adjusted every week or every two weeks since, especially before the age of one year, the skull grows very rapidly. However, if positional treatment is carefully followed, along with all the precautions suggested above, and especially if plagiocephaly is diagnosed within the first few months of life, helmet therapy might not be necessary.

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