Children's Hospital Colorado

Positional Plagiocephaly

What is positional plagiocephaly?

Positional plagiocephaly, also known as deformational plagiocephaly, is a condition in which one side of the back of a baby's head is flattened. It is different from lambdoid craniosynostosis in that there is no associated early suture fusion and the physical findings are distinct. Positional plagiocephaly does not affect brain development and is of cosmetic and psychosocial concern only.

Who gets positional plagiocephaly?

There are many factors that can contribute to flattening of the back of the head in a baby. These factors can have an effect either prenatally or after birth. Babies with less room in utero are more prone to positional plagiocephaly. This crowding can be due to multiple babies (twins, triplets, etc.) or a condition of the uterus (fibroids). Premature babies are at an increased risk of deformation due to external forces because their skull bones are softer.

Babies may have a positional preference in one direction or the other, meaning that s/he may simply keep the head turned one way most of the time. This can lead to flattening on this side. In 1992, the American Academy of Pediatrics recommended that healthy term infants be placed supine (lying on the back) for sleep. The Back to Sleep Campaign resulted in a reduction in the risk of Sudden Infant Death. However, the incidence of posterior positional plagiocephaly increased. The positional preference may also be due to torticollis (tight neck muscles) or visual problems.

What are the symptoms of positional plagiocephaly?

You or your baby’s healthcare provider may notice a flat spot on the back of the head. Depending on the severity of the deformation, the ear and forehead on the affected side may be pushed forward.

How is positional plagiocephaly diagnosed?

You or your healthcare provider may first note asymmetry of your child’s head shape. Your pediatrician may examine your child for distinct features that help make the diagnosis of positional plagiocephaly versus craniosynostosis. Occasionally, an x-ray or CT scan is needed to help make the differentiation.

Call 720-777-5578 to make a referral or schedule an appointment with the Plagiocephaly Clinic nurse practitioner associated with the Craniofacial Center. Examination, diagnosis and education can be provided at this appointment.

How is positional plagiocephaly treated?

Your child will be evaluated for any associated problems, such as torticollis or strabismus, to assure that there is not an underlying cause that needs to be treated as well. If this is the case, physical therapy or a referral to an ophthalmologist may be recommended.

The first recommendation for improving the head shape in positional plagiocephaly is changing your child's sleeping position. Always place your baby on his or her back for sleeping. Lay your baby so that the head is at alternating ends of the crib. Some babies tend to turn their heads towards the nursery entryway, and you can use this to your advantage when you position your child. Arrange toys, music players and mobiles in such a way that your child must turn his or her head away from the flattened side to enjoy them. Alternate the way you carry your baby to encourage head movement; change the direction your baby faces whether on your hip or in your arms. Supervised tummy time when your baby is awake is also very helpful.

A 3-dimensional image of your child's head shape will be captured, followed and compared at intervals by using cutting-edge technology. We are able to use software associated with this photography system to track the progress of your child and monitor whether treatment is working. We can use this information to make changes in the plan.

If your child's condition is very severe, or is unresponsive to positioning changes, a molding helmet may be recommended. If appropriate, the helmet is usually worn 23 hours per day for 4-6 months before seeing appreciable and satisfactory improvement. If needed, the helmet is applied around the age of 6 months and worn until the head shape is improved (approximately one year of age). The molding helmets require frequent adjustments, as babies' heads grow rapidly in the first year of life.

Positional plagiocephaly tends to improve with positioning changes and as the baby becomes more active with age. Crawling, sitting and pulling to a stand are activities that take away any deforming forces. By 14-16 months of age, the skull shape usually has significantly improved. Surgery is not needed for positional plagiocephaly.

The Plagiocephaly Clinic at Children's Colorado

The Plagiocephaly Clinic is run together once a month with the Craniofacial Clinic. It is led by a nurse practitioner with specialized training in positional plagiocephaly. Patients may be referred to the Plagiocephaly Clinic for evaluation, diagnosis and education.

A 3-dimensional image of your child's head shape will be captured, followed and compared at intervals by using cutting-edge photographic technology. We are able to use software associated with this photography system to track the progress of your child and monitor whether treatment is working. We can use this information to make changes in the treatment plan. Referrals for specialist consultation, physical therapy or molding helmets may be made through the Plagiocephaly Clinic.

To make a referral or schedule an appointment, please call 720-777-5578.


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