Plagiocephaly (plā-jē-ō-ˈsef-ə-lē) is a term which refers to a flattening of a baby’s skull. It can be due to craniosynostosis or positional molding.
Craniosynostosis (krā-nē-ō-ˌsi-ˌnä-ˈstō-səs) is a condition where the bones of the baby’s skull grow together too early. Plagiocephaly or flattening can occur in the front (anterior plagiocephaly) or back (posterior plagiocephaly) of the skull.
Positional plagiocephaly is a very common type of positional molding. It usually involves the back of the skull. Unlike craniosynostosis which involves bone growing together, positional molding results from the baby’s head being in one position too long. It does not affect a child’s brain growth or cause developmental delay or brain damage.
A baby’s skull is made up of several thin plates of bone. Between each plate is a fibrous, flexible joint called a suture. This allows the infant’s skull to be malleable (able to be shaped).
Signs and Symptoms
The common sign of positional plagiocephaly is a markedly flat area on the back of the head.
Positional molding may be related to the fetus’s position in the womb or to the birth process. In this situation, the abnormal head shape usually goes away within several days of being born.
Positional plagiocephaly typically results from the baby sleeping on its back or spending too much time in a car seat or rocker. There has been an increase in positional plagiocephaly with the recommendations that a baby should sleep on its back to reduce the risk of SIDS (sudden infant death syndrome). Most cases of positional plagiocephaly appear at about 7–12 weeks of age and are mild in form.
Positional plagiocephaly is generally diagnosed through medical history and physical examination alone. The head shape can be flat on one side or across the back.
Positional plagiocephaly usually does not require surgical intervention. Treatments include:
- Positional therapy Treatment involves activities that promote re-positioning of the baby’s head to get it off the flat spot. Unfortunately, a baby becomes used to laying on the flat spot and it becomes a means of comfort, much like a pacifier. Positioning activities include placing things of interest on the side opposite the flattening to increase their interest in having their head turned to the other side. Your baby should also get a combined total of 30 minutes of supervised “tummy” time each day. This helps promote shaping of the back of the head as well as strengthening of the neck and arm muscles which are needed for crawling and sitting up.
- Orthotic molding helmet treatment may be recommended for severe or persistent plagiocephaly. Helmets work best if started between 4 and 6 months of age. Treatment usually lasts 3–6 months, depending on how early it is started and the severity of the flattening. Treatment is usually completed by 1 year of age. The helmet works by applying gentle but constant pressure in the area of the skull that is not flat. This allows the flat area to round out as the head grows. The helmet is typically worn for 23 hours per day in order to work properly. Frequent follow-up (weekly to every other week) with the helmet supplier is needed for assessment and adjustments.
Our pediatric neurosurgery providers at Goodman Campbell are specially trained on this diagnosis and are experts in the care of craniosynostosis and positional molding. We know these issues can make families very anxious. Our team of medical professionals are available to answer any questions or discuss any concerns that you might have.
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