What is Plagiocephaly in Babies?
As a parent of a baby with plagiocephaly, I found myself wondering why I really never knew exactly what plagiocephaly was before I was personally affected. I had heard of “flat head syndrome” and kept an eye out for signs. Although I thought I was informed, I really didn’t know much about plagiocephaly (definitely didn’t know that term), the causes, potential preventative measures, treatments, etc.
Whether you are or are not personally affected by plagiocephaly, having accurate information can help you be supportive, proactive, and just have an overall understanding of plagiocephaly.
What is plagiocephaly?
Plagiocephaly is pronounced play-jee-oh-sef-ah-lee (or plā-jē-ō-ˈsef-ə-lē).
So, what is plagiocephaly exactly? Plagiocephaly refers to an oblique head shape. This will look like flatness on the side or back of the head. The flatness of the side of the head can result in asymmetry in other parts of the head and face, such as one cheek appearing fuller, misaligned ears, or one eye that appears smaller. When there is flatness on the back of the head, this could cause ears to protrude and the head to appear tall and wide.
How is plagiocephaly diagnosed?
While plagiocephaly may be detected through simply seeing a baby’s head shape, receiving a diagnosis from a healthcare professional that treats plagiocephaly usually includes some type of imaging of the baby’s head. Some specialists do not require a referral to do a consultation (although a referral will likely be needed to move forward with treatment). Some providers may even do the consultation for free! The images are used to take measurements and identify the severity of plagiocephaly.
Common types of plagiocephaly:
Plagiocephaly technically refers to any oblique head shape but may also be more commonly used to describe flatness of the side of the head.
Brachycephaly refers to flatness of the back of the head.
Scaphocephaly is when the head appears long and narrow due to flatness on both sides of the head.
What causes plagiocephaly?
Many people have the misconception that a “flat head” is solely caused by a baby being placed on their back often, such as for sleep. However, there is more to understand on the topic of plagiocephaly causes.
Some causes of plagiocephaly:
Baby’s position in utero can contribute to plagiocephaly. Some factors: position in the womb, shape of the uterus, and pregnancy with multiple.
Torticollis, which is tight neck muscles. This can go hand-in-hand with the baby's position in utero and can also be caused by the birthing process. When a baby’s neck muscles are tight, they will favor a side which can cause more pressure to be on that side of the head, leading to plagiocephaly (or possibly plagiocephaly leading to torticollis). It is common for a baby with plagiocephaly to also need some treatment for torticollis.
Position as an infant: Spending a lot of time on their back, such as during sleep, in a car seat, in a baby swing, etc. can contribute to plagiocephaly.
Premature babies are at increased risk for plagiocephaly. Their skulls are very malleable and they may spend a lot of time in back or side-lying positions influencing head shape.
Craniosynostosis: A condition in which a baby’s bones in their skull fuse together too early. This is typically due to genetic mutations. (Learn more about craniosyntosis here: https://www.cdc.gov/ncbddd/birthdefects/craniosynostosis.html)
Does placing my baby on their back cause plagiocephaly?
A baby’s skull is very soft, and even gentle pressure (while in utero or in the early months) can contribute to a baby’s head shape. If a baby spends time with their head facing one direction more often while lying on their back, that side of their head will have more gentle pressure placed on it. For example, a baby with torticollis may spend more time in one direction due to the neck muscle tightness. That all being said, placing a baby on their back does not specifically cause plagiocephaly, but can contribute to positional plagiocephaly.
In the 90s, the “Back to Sleep” campaign was launched to decrease instances of Sudden Infant Death Syndrome (SIDS). Although increased time a baby spends on their back by placing them to sleep on their back increases the potential for positional plagiocephaly, there is a safety concern for placing a baby to sleep in any other position. (Check out our Safe Sleep 101 blog for more information on why it is recommended from a safety standpoint to place a baby to sleep on their back!) Placing a baby on their back for sleep, play, car rides, in a baby swing while you cook a meal, etc. does not cause plagiocephaly. However, prolonged time spent on their back can contribute to positional plagiocephaly.
Is plagiocephaly bad?
NO! Plagiocephaly is not “bad” but there is a misconception that plagiocephaly is “just cosmetic.”
A diagnosis of plagiocephaly may come with some treatment like a helmet (cranial orthotic) or treatment, such as physical therapy. Plagiocephaly is usually categorized as mild, moderate, or severe (based on measurements collected during evaluation for plagiocephaly). In some cases, parents may choose not to treat plagiocephaly at all or by intervening at home using suggested exercises by their healthcare provider.
Plagiocephaly, in general, does not indicate that there will be other serious health concerns. There is no indication that brain development will be impacted by plagiocephaly. There IS research and anecdotal information that untreated plagiocephaly can result in other functional and developmental influences, such as eye sight concerns due to asymmetry of the face. Here is an article that discusses potential influences of plagiocephaly and ear infections. There are also things that can be affected if plagiocephaly goes untreated, like not being able to fit properly in a safety helmet for sports or trouble with eyeglass fitting. Also, in some cases, when plagiocephaly is caused by craniosynostosis, there may be other treatments that are necessary.
It is ALWAYS suggested that you discuss any concerns regarding your baby’s head shape and possible treatment options with your child’s health care providers. And, if you do not receive information that puts you at ease, you can always seek out other providers.
How to prevent plagiocephaly?
For some babies, there is really no way to prevent plagiocephaly. Referring back to the causes of plagiocephaly, some babies may have plagiocephaly due to other medical conditions or due to things that happened while they were in utero, during birth, or shortly after birth.
In some situations, frequent opportunities for supervised tummy time while a baby is awake may help with preventing positional plagiocephaly because the baby has time spent without pressure on the back of their head, essentially to counter the time spent on their back while sleeping and other activities. You may notice that the push for “tummy time” aligned with the “Back to Sleep” campaign. There are many benefits for a baby spending time on their tummy (while supervised), and emphasizing tummy time gives a baby time without pressure on the back of their head. There are also benefits to time spent in a side-lying position. In general, there are benefits to frequent changes in position while a baby is awake and supervised.
Does plagiocephaly go away?
Yes, plagiocephaly can “go away” but that typically means that sometimes was done to help correct plagiocephaly, whether that is through a helmet, or cranial orthotic, physical therapy, or time spent on your own
Will plagiocephaly correct itself?
It is also not uncommon that a parent may be told that plagiocephaly will “correct itself.” I hate to say it, but this advice is NOT the most helpful. While it is possible that a baby with plagiocephaly may have a head shape that appears more evenly rounded as they get older, this will typically be because the baby may have had a more mild case and as they developed skills, such as rolling and sitting, they were no longer in positions as often where pressure was placed on their skull.
Some things that may be helpful to correct (and prevent) plagiocephaly:
Frequent time spent in positions other than on the back (while awake and supervised) - tummy time, side lying, being held upright, etc.
Vary the location in their sleep space that you place them. For example, switch from placing the baby down where they have to look over their left shoulder or right shoulder to see the door.
Encourage your baby to look in different directions so they are moving their head to both sides, even during play while they are on their back.
Hold your baby in varying positions. Certain positions can also help with muscle tightness if a baby has torticollis.
If you are bottle feeding, switch directions for feedings.
How can plagiocephaly be corrected?
Depending on the cause of plagiocephaly, there are treatments available, such as a cranial orthotic (aka helmet) and physical therapy. Often times a baby that has torticollis will also have plagiocephaly, and a combination of interventions will typically be recommended.
Are helmets necessary for plagiocephaly?
Helmets are not always necessary to treat plagiocephaly. If plagiocephaly is identified in a young infant while their skull is more malleable, there may be activities and treatment like physical therapy that can be effective at treating plagiocephaly without a helmet. However, if a helmet is recommended due to a baby’s age, severity of plagiocephaly, etc. please know that your baby will likely adapt just fine! Check out our blog on Sleep Tips for Babies in a Helmet.
If you are interested in learning more about plagiocephaly, here are some articles:
Babies sleep position, prevention, and management of deformities in head shape
Prevalence, risk factors, and history of plagiocephaly
Potential effects of untreated plagiocephaly and importance of early intervention
Diagnosis and management of plagiocephaly
Quality of life for babies with helmets (and their caregivers)
As a fellow mom who had a baby with plagiocephaly, I understand the feelings of concern and guilt. I want you to know that your baby’s plagiocephaly is in no way your fault!
Medical Disclaimer:
The information provided is not medical advice. Reliance on the advice is solely at your own risk. The advice is for informational purposes only. The information provided is not intended nor is implied to be a substitute for professional medical advice. Always seek the advice of your physician with any questions you may have regarding a medical condition or the health and welfare of your child, and before following the advice or using the techniques offered in this consultation. In no event will Sarah Mechling and Heaven Sent Sleep be liable to you for any claims, losses, injury or damages as a result of reliance on the information provided. While all attempts have been made to verify information provided, Sarah Mechling and Heaven Sent Sleep does not assume any responsibility for errors, omissions, or contrary interpretation of the subject matter herein. Readers use any advice at their own risk.
