Positional Plagiocephaly

What Is Positional Plagiocephaly?

The flattening of one side of your baby’s head is called plagiocephaly. Positional plagiocephaly, also known as deformational plagiocephaly, is the most common type of plagiocephaly. As you know, your baby’s head is “soft.” This softness is necessary to allow for the rapid growth a baby experiences, especially in the first year of life. It also makes your baby’s head susceptible to temporary flattening if he or she frequently lies on just one side of the head. Positional plagiocephaly is usually an issue only in the first few months of life, because infants cannot yet turn by themselves.

Our craniofacial team includes internationally renowned surgeons and 18 clinical specialists, all who are dedicated to helping families with children affected by head and neck birth defects. Our goal is to provide your child with the best possible comprehensive treatment by using the latest technology and time-honored, heart-felt care.

Causes of Positional Plagiocephaly

Although you might be worried that your baby’s head is becoming flattened, rest assured that positional plagiocephaly is temporary. 



Positional plagiocephaly is caused by pressure on the bones of the skull before or after birth. A baby’s skull has sutures, or joints, that are not yet fused. These sutures are necessary so that the skull can accommodate the brain’s rapid growth. 



You may notice that your baby prefers to sleep on one side of his or her head more than the other, which is also the side that is flattened. For example, if your baby lies mostly on his or her back, then the back of the head is most likely the side that is flattened. 



In addition to sleeping on one side, other causes of positional plagiocephaly may include:
  • Multiple medical problems that cause delayed development, including the ability of an older baby to change positions.
  • Tightened neck muscles that limit range of motion. 
  • Premature birth because the skull of a premature infant is softer than that of a full-term baby. 
  • Crowding in the womb due to a multiple pregnancy or fibroids in the uterus that causes pressure on the baby’s head.

Symptoms of Positional Plagiocephaly

Your baby’s positional plagiocephaly may be difficult to notice or it can be quite obvious, depending on the degree and the location of flattening. 

The most common area of a positional plagiocephaly is the back of the head, but sometimes the forehead can become uneven.

Your pediatrician will want to examine your child’s head carefully to feel for bony ridges because positional plagiocephaly can sometimes look like a more severe condition called craniosynostosis, where some of the sutures in the skull close too early.

This should be used as a guideline. Not every symptom is included. If your child has one or more of these symptoms, it does not mean that he or she has positional plagiocephaly. If you are concerned that your child might have positional plagiocephaly, please make an appointment with your child's doctor.

Treatments for Positional Plagiocephaly

Most cases of plagiocephaly can be helped by making sure that your baby does not lie on one side of his or her head for too long. Try to keep your child off the flat part of the head as much as possible. If your baby has a limited range of motion in his or her neck due to muscle tightness, physical therapy can help with range of motion.

Children with moderate to severe plagiocephaly might need a special helmet. Generally, the helmet is worn about 23.5 hours every day. 
Babies with plagiocephaly need more time sitting upright. Limit the time your baby spends lying down in cribs, playpens, car seats and strollers. Make sure your baby gets plenty of tummy and play time to help develop skills that may be delayed, such as crawling, rolling, reaching, pushing, and grasping.

Preventing Positional Plagiocephaly

Starting on the day of birth, babies should have their heads  turned to one side, alternating between sides when they are placed back to sleep (i.e. turn head to the left on day 1, to the right on day 2, to the left on day 3, etc). Also, starting as early as the first day of life, babies should have SUPERVISED tummy time at least 3 times a day for 10 - 15 minutes each time. If a child has reflux, a rolled towel can be placed under the upper chest to relieve pressure on the abdomen. These interventions may also help manage positional plagiocephaly in babies who were born with it.

At the Yale Craniofacial Program, your child will receive care from some of the top surgeons and specialists in the world. We care deeply about your child’s immediate and future emotional and physical well-being.