Positional Plagiocephaly

Symptoms of Positional Plagiocephaly

Positional plagiocephaly can look different depending on which part of the skull has a flat spot. It can be very mild and hard to see, or it can be very easy to see.

• Often only the back of a baby’s head has a flat spot.
• Sometimes the forehead or face is also uneven.
• Usually the flatness is more on 1 side than the other (asymmetric). This is because babies like to rest on one side more than the other.
• Sometimes the flatness only affects the middle of the back of the head (symmetric). That happens if a baby always lies without turning their head.

Flat spots in a young baby’s head are common and do not always mean there is a problem. Your child’s doctor or nurse practitioner will check to see if your baby needs treatment.

Diagnosing Positional Plagiocephaly

To diagnose this condition, your child’s doctor or nurse practitioner will check your child’s head for features like:

• Bony ridges
• Flat areas
• Uneven forehead
• Two sides of the face that do not match each other (asymmetry)
• Ears that look different from each other

Your child’s healthcare provider will also check your child’s development. Some children with this condition have mild developmental delays. Read about Seattle Children’s research into the link between delayed development and positional plagiocephaly.

Positional plagiocephaly can sometimes look like a condition called craniosynostosis. These conditions need very different kinds of treatment. Our team is experienced in looking for the signs that help us tell these conditions apart.

Treating Positional Plagiocephaly

Treatment depends on the cause, your child’s age and how much their skull is affected.

• If muscle tightness limits your baby’s movement in the neck (torticollis), our team may recommend exercises or refer you to a physical therapist (PT).
• If lying in the same position is the cause and your baby is 5 months or less, the most important treatment is to change the position of their head when they lie down. Our team will help you learn to keep your baby off the flat portion of their head as much as possible. It is still important to put babies to sleep on their backs to lower the risk of sudden infant death syndrome (SIDS).
• If changing your baby’s position does not reduce the flatness and your baby is 6 months or older, a special helmet may help fix your baby’s uneven head shape.

Helmet therapy

If positional plagiocephaly is moderate or severe, your healthcare team will talk to you about whether helmet therapy is right for your baby.

At Seattle Children’s, we use the Starband helmet. It fits snugly on the round parts of your baby’s head but is looser on the flat parts. This gives the flat parts more room to expand as your baby’s head grows.

Your baby wears the helmet 23 hours each day. How long treatment lasts depends on your baby’s age and how severe the flatness is. Often children wear the helmet for 4 to 5 months.

Preventing Plagiocephaly

To prevent problems with plagiocephaly:

• Always place your baby to sleep on their back. This is the safest way.
• When your baby is awake, find ways for them to play and move while on their tummy. Do this several times each day.
• Choose different positions and ways for your baby to play and be held. Variety is important.
• Give your baby a lot of time sitting in laps and cuddling. When they are awake, avoid long periods lying on their back or strapped into infant seats or car seats.
• Encourage crawling, rolling, reaching, pushing, pulling, holding and grasping. 

It is OK to use strollers, car seats, infant seats, bassinets, cribs and play pens when necessary. But remember that babies need chances to move that do not happen while sitting in only one position.

Research to Improve Care

We receive more research funding from the National Institutes of Health (NIH) than any other craniofacial center in the United States.

Our researchers are studying development in children with positional plagiocephaly compared to children without it.

Earlier studies by Seattle Children’s found developmental delays in infants, toddlers and preschoolers with positional plagiocephaly compared to children without positional plagiocephaly.

As the study continues, our researchers will measure the children’s development at 8 years. Researchers want to know if children with better motor skills (like walking and running) also have better cognitive (brain) development.

The findings do not show that plagiocephaly causes developmental delays. In fact, it may be the opposite. Researchers think the condition may be a “marker” that could identify if a child is at risk for delayed development. They recommend that all babies with flattened skulls be screened for developmental problems.