Boston Othotics and Prosthetics

Understanding Plagiocephaly for Parents

Plagiocephaly is a relatively common condition characterized by a flat spot on the back or side of a baby’s head. Don’t worry, it is no one’s fault and can be easily and quickly treated.

Plagiocephaly, also called "flat head syndrome," can be caused when the baby’s head frequently rests in the same position on everyday surfaces such as a mattress or car seat, or it can even happen in the womb. It can develop in as little as one week and is present to some degree in nearly half of infants. It does not affect neurological development, but if left untreated can result in the head being permanently misshapen, which can cause other issues including facial asymmetry, difficulty fitting helmets and eyeglasses, and jaw misalignment.

Types of Cranial Asymmetry

Plagiocephaly is commonly used as a catchall term for various types of cranial asymmetry, but there are actually several types that refer specifically to where on the baby's head the flatness occurs.

  • Plagiocephaly is defined as a flattening on one side of the baby's head.
  • Brachycephaly is less common than plagiocephaly, and refers to a uniform flattening of the entire back of the head. Occasionally the forehead will also bulge out.
  • Asymmetrical Deformational Brachycephaly (ADB), is a combination of plagiocephaly and brachycephaly that results in flattened back of the head leading to an excessively wide head as well as an asymmetrical appearance.
  • Scaphocephaly is when the baby's head is long and narrow with a wide forehead. The sides of the head may also appear flattened. Unlike plagiocephaly and brachycephaly, which are usually positional, scaphocephaly is often congenital and is most commonly seen in premature infants.

What Causes Plagiocephaly?

Many factors can be associated with cranial asymmetries. Some occur before birth because of limited space in the uterus, which is more common with:

  • Multiple births
  • First born children
  • Breech births
  • Male babies

Some asymmetries also occur during or after birth as a result of factors including:

  • Long labors
  • Extended time in the NICU
  • Poor muscle tone
  • Spine abnormalities
  • Positioning
  • Neck muscle tightness (torticollis)

Another contributing factor is the "Back to Sleep Campaign," developed in 1992 by the American Academy of Pediatrics to encourage parents to place sleeping infants on their backs. Although the program has led to a reported 70% reduction in the rate of Sudden Infant Death Syndrome (SIDS), an increase in the number of infants with cranial asymmetries has been noted.

How Can I Identify Plagiocephaly?

Starting at 3 months of age, as part of a well-child exam, your child’s pediatrician will measure your child’s head and check for cranial symmetry. If there is an asymmetry of 8mm or more, your child needs to be examined by a certified orthotist, who will prescribe treatment and track progress.

Treatment Options for Plagiocephaly