What is Plagiocephaly?

Plagiocephaly is a word that describes abnormal head shape, often flattening, of one side of the skull. There are a number of reasons that a baby’s head shape may not be round and equal.  An early and thorough evaluation is important to figure out the cause and plan a course of treatment.

Plagiocephaly may develop when the baby’s rapidly growing head meets some kind of resistance. Babies’ heads grow to 75 percent of an adult size by two years of age. This resistance can be in the womb before the baby is born, or after birth when the baby’s head is on a flat surface such as the bed or against a car seat.

The bones of babies’ skulls are very thin and flexible, like “shirt cardboard”. Constant pressure in one area of the skull can alter the shape of the skull. This is one of the most common forms of an abnormal head shape.  In other cases, your child may have tight neck muscles causing he or she to twist the neck to one side (torticollis). Then when you child is lying down, one area of the head is consistently pressed against the bed and the area flattens. Babies with plagiocephaly often have noticeable flatness on the backs or the sides of their heads, and hair may not be as thick in those areas.

The incidence of plagiocephaly has increased since the American Academy of Pediatrics came out with recommendations for parents to have their babies sleep on their backs to prevent Sudden Infant Death Syndrome.  Car seats, strollers, and other carriers also often position babies on their backs.  

How can plagiocephaly (head flattening) be treated?  

Treatments range from a simple repositioning of babies to more aggressive measures.  Treatment starts with the parents repositioning their baby below the age of five months onto his or her side or stomach to relieve pressure on the side or the back of the head. This needs to occur when baby is awake. Babies should still be placed on their backs to sleep.

Changing the position of the crib in the bedroom relative to the light source so the baby has to turn to see what is interesting, utilizing Tummy Time for 60 minutes or more when awake, several times daily, and minimizing time spent in car seats, can be helpful. As early as three months, parents could consider utilizing a “bouncy seat” when awake, thus the baby is spending much less time on his or her back. All feeding and cuddling should position baby to avoid the flattened side of the head. Infants with torticollis require dedicated physical therapy to stretch and straighten the neck. Through successful treatment of the torticollis, the head flattening usually improves.

What are plagiocephaly helmets and why are they used?

When the flattening is significant, helmet therapy may be indicated. Helmet therapy is most effective when initiated at or before the age of six months. Usually by one year of age, it becomes more difficult to keep the helmet on the child. He or she will have the dexterity to reach up and remove it. In addition the bone becomes hard at one year of age and more difficult to mold.

These special helmets help distribute pressure around the baby’s entire head. This distribution of pressure helps prevent further flattening and promotes growth to a more rounded head shape.

The average length of treatment is from three to six months, depending on the age of the baby and how severe the condition is. Helmets are worn 23 hours per day, removed only for bathing.  Frequent monitoring and careful adjustment is necessary for successful remodeling of the skull.  Babies will visit the orthotist every few weeks for adjustments as necessary, and will visit the plastic surgeon every few months for overall evaluations as well.

If you have questions about your infant’s head shape, contact the Cleft and Craniofacial Clinic at Riley at IU Health to determine if your child could benefit from evaluation and treatment.

Patricia M. Terrell, MSN, CPNP

Author of this Article

Pat has been involved with Plastic Surgery patients at Riley at IU Health for over 30 years. Her early years were spent in the Operating Rooms, where she was in charge of Plastic Surgery. Since the mid 1990's, Pat has been supporting the Craniofacial Team as a nurse practitioner. Pat has been a member of the American Cleft Palate-Craniofacial Association since 1982 and has served on the Donna-Pruzansky Memorial Fund for Maternity Child Health Nursing committee.

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