Signs of Plagiocephaly

Plagiocephaly, also sometimes called flat head syndrome, develops when an infant’s soft skull becomes flattened in one area, due to repeated pressure on one part of the head. It typically develops in infants. Treatment for plagiocephaly usually includes special exercises, varying sleep position or wearing a helmet.

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Symptoms

There are really no symptoms for plagiocephaly other than the appearance of a flattened head. This is typically the only symptom; it is not painful and does not affect the baby’s day-to-day life or abilities.

Plagiocephaly is actually just one category of 3 that a flattened head can fall into. A flattening head is usually categorized as plagiocephaly, brachycephaly and scaphocephaly depending on the shape of the head. 

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Plagiocephaly head shape

• Head is flat on either the back right or left side
• Head shape resembles a parallelogram
• Ears are not aligned; one ear is closer to the shoulder than the other
• One side of the head appears more curved than the other

Brachycephaly head shape

• Head is wider than it is long
• Back of head is flat rather than curved
• Head is shortest in length from front to back
• Head is tall in back
• Sloping forehead

Scaphocephaly head shape 

• Head is long and narrow
• Head is longest in length from front to back
• Head is narrow
• Forehead is square and elongated

What causes my baby’s head to get flat?

Babies' heads are very malleable, so anything that puts pressure on the skull can cause flat head syndrome. 

If your baby is born with a flat or misshapen head, it's known as molding. This common condition usually resolves on its own within a few days. A few common reasons for a misshapen head at birth include:

• Prolonged labor
• Pressure put on the skull during the trip through the birth canal.
• Assisted-delivery devices such as vacuums or forceps, which can mold the skull.
• Torticollis, a fairly common condition characterized by stiff, tight neck muscles in your baby. Click here for more on torticollis.
• Putting baby to sleep on their back on a firm mattress, which puts pressure on the back of the head.
• Laying baby flat in a car seat or swing for long periods of time.

Positional plagiocephaly is a condition in which a flat spot develops on a baby’s head when a baby spends too much time on their back. Flat spots may form on one side of the head if the baby's head is frequently turned to one side. Parents concerned about head shape should make sure their first priority is to prevent SIDS and other sleep disorders. Back-sleeping may increase the risk of flat head syndrome, but it reduces the risk of SIDS, so it's worth the trade-off.

While it may be alarming to notice a flat spot on your baby’s head, the flat spot won’t affect your baby’s brain development. 

Plagiocephaly is not the only cause of a misshapen head. Craniosynostosis (sometimes also referred to as congenital plagiocephaly) is a condition when the cranial sutures begin to prematurely fuse. There are different types of craniosynostosis and if your therapist has concerns, they may refer you to a specialist. 

How do you treat flat head syndrome?

For mild forms of positional plagiocephaly, you can encourage a normal head shape by:

• Alternating head position: Back sleep is still the safest way for your baby to sleep. Still, you can help prevent a flat spot on the back of your baby’s head by alternating the position of their head each time you put them down to sleep.

• Moving baby frequently: Frequently moving your baby among the floor, bouncer chair, swing, and other spots reduces the time babies spend putting pressure on one part of their head.

• Practicing tummy time:  The more time babies can spend off their backs while awake, the less likely they are to develop flat spots. 

• Carrying your infant: Holding your baby and using a sling or other soft carrier helps keep pressure off your baby’s head. Additionally, try alternating the arm you hold your baby in while feeding.

If positional changes alone aren’t improving the shape of your baby’s head enough, a helmet may be recommended. Helmets can help to mold the skull and treat flat spots. 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. As your baby grows, the helmet will need periodic adjustments so it's important that it is carefully monitored by a licensed professional. 

Your doctor may refer your baby to physical therapy if they have tight muscles. Tight muscles can cause your baby to keep their head in the same position and to limit the range of motion in their neck. A pediatric physical therapist can help babies increase their range of motion and relieve tight muscles.

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.

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