Plagiocephaly is a very common skull and face problem. In fact about 46% of infants suffer from it. Deformational plagiocephaly, means a misshapen, flat or asymmetrical (uneven) head shape. Plagiocephaly does not usually affect the development of a baby’s brain, but if left untreated it may change their physical appearance by causing uneven growth of their face and head;
Plagiocephaly occurs because the bones of a newborn baby’s head are thin and flexible, so the head is soft and may change shape easily. Flattening of the head in one area may happen if a baby lies with their head in the same position for a long time. When the head has a flat spot at the back of the skull, this is called brachycephaly;
What causes plagiocephaly?
It is quite common for a newborn baby to have an unusually shaped head. This can be either related to their position in the uterus during pregnancy, or caused by moulding (changing shape) during labour, including changes caused by instruments used during delivery. Depending on the cause of the unusual shape, most babies’ heads should go back to a normal shape within about six weeks after birth;
Sometimes a baby’s head does not return to a normal shape, or they may develop a flattened spot at the back or side of their head. Sometimes a flat spot develops when a baby has limited neck movement and prefers resting their head in one particular position;
Can I do something to prevent plagiocephaly?
You need to change your baby’s head position during sleep and when he/she is awake to avoid developing plagiocephaly;
When breastfeeding, alternating breasts also naturally alternates your baby’s position. You should alternate sides also when bottle-feeding;
Always place your baby on his/her back to sleep to reduce the risk of SIDS (Sudden Infant Death Syndrome or Cot Death). Do not use pillows in the cot for positioning;
Your baby will generally stay in the position he/she is placed for sleep, until he can move himself. It is a good idea to alternate your baby’s head position when they sleep. Place your baby at alternate ends of the cot to sleep, or change the position of the cot in the room. Babies often like to look at fixed objects like windows or wall pictures , so changing their cot position will encourage them to look at things that interest them from different angles;
When your baby is awake and alert, play with them facing you or place them lying down on their front (tummy time) or on their side from as early as one or two weeks of age. Place rattles or toys (or other people’s faces) that your baby likes to look at in different positions to encourage your baby to turn their head both ways. Even at two weeks of age your baby can follow your voice or eyes (maintain eye contact) and turn their head themselves each way if you support their head in your hands while they are awake and alert;
You should avoid having your baby lying down too much by varying their position throughout the day, e.g. use a sling, hold them upright for cuddles, carry them over your arm on their tummy or side;
When should I seek help from my GP/paediatrician?
If you have concerns about your baby’s head shape or if you notice that your baby only turns their head to one side when lying on their back, see your GP/paediatrician;
Is there any remedy for plagiocephaly?
Some good news: most babies with deformational plagiocephaly do not need any treatment at all, especially if they are active. Your baby’s plagiocephaly usually improves naturally as your baby grows and gains head control and can move their head by themselves;
Encourage your baby to turn their head themselves when they are awake as this will help the plagiocephaly to get better. From the age of two weeks, while you are supporting their head in your hands, your baby can slowly follow your eyes or voice around, even if one way seems harder at first. So call him/her from different directions and he/she will follow you;
Your GP/paediatrician may refer your baby to a specialist clinic where he/she will be treated by a team that may include a paediatrician, plastic surgeon, physiotherapist and orthotist;
The physiotherapist is your best friend as he/she will encourage active movement, and teach you how to position your baby and do exercises to help improve the head shape;
A very small number of babies with plagiocephaly (less than one in 10) have a severe and persistent deformity, and they may need to be treated with helmet therapy;
A lightweight helmet is made by an orthotist using 3D images and fitted for your baby. The helmet helps to reshape the skull by taking pressure off the flat area and allowing the skull to grow into the space provided;
Helmet therapy is most effective if treatment starts between six and eight months of age and is completed before 12 months, as this is the time of rapid growth of the skull;
Wearing the helmet doesn’t hurt and your baby will usually get used to it very quickly. Parents can sometimes feel quite emotional when their baby first wears the helmet. It can be helpful to know this is a common feeling and to remember treatment is temporary and outcomes are typically excellent;
How do I care for my baby with helmet therapy?
There should be some space in the helmet for your baby’s ears. Make sure that his/her ears sit comfortably in these spaces and the helmet is not twisted;
When you take the helmet off, check your baby’s skin to make sure there is no rubbing, blisters or broken skin. A slight redness over the high spots of the head is normal;
You can put aqueous cream on dry skin or mild rashes;
Try to keep your baby helmented even during hot weather. Dress him/her in light clothing or alternatively use a fan or an AC;
Your baby’s head will become sweaty under the helmet. You should wash your baby’s hair daily and clean the inside of the helmet with a face cloth and warm, soapy water. Rinse the helmet well and towel dry;
Take home message
Lie your baby on their back for sleep and do not use pillows in the cot.
Vary the position of your baby’s head when putting them down to sleep, and your baby’s position when they are awake and alert. Give your baby face time and tummy time.
Do talk to your GP/peadiatrician if you are worried about your baby’s head shape.
Plagiocephaly usually improves over time if your baby is active and has lots of one-on-one interaction.
If helmet therapy is needed, it won’t hurt your baby and the outcomes are normally very good.
References
Blanco-Diaz M, Marcos-Alvarez M, Escobio-Prieto I, De la Fuente-Costa M, Perez-Dominguez B, Pinero-Pinto E, Rodriguez-Rodriguez AM. Effectiveness of Conservative Treatments in Positional Plagiocephaly in Infants: A Systematic Review. Children. 2023 Jul 7;10(7):1184.
Jung BK, Yun IS. Diagnosis and treatment of positional plagiocephaly. Archives of craniofacial surgery. 2020 Apr;21(2):80.
Aarnivala H, Vuollo V, Harila V, Heikkinen T, Pirttiniemi P, Valkama AM. Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial. European journal of pediatrics. 2015 Sep;174:1197–208.
Disclaimer
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The information in this Blog is provided for educational purposes only. It is not intended as medical advice. Kindly consult your family doctor or your paediatrician if you have any concerns about your child’s health.
Copyright
Copyright Dr. Eugenio Azzopardi, Consultant in Paediatric Emergency Medicine. All rights reserved
