Plagiocephaly (sometimes referred to as flat head syndrome) is a flat spot on the back or side of a baby’s head. It is caused by external pressure on the bones of the skull before or after birth.
Plagiocephaly can occur due to the way a baby tends to lie (their positional preference) in their first few months of life. The occurrence of plagiocephaly has increased since the “Back to Sleep” program was implemented in the 1990s. Another cause could be crowding in the womb (twins, triplets, etc) or extended periods of time in car seats or infant carriers.
Some infants have limited flexibility in the neck muscles, which is called torticollis. Torticollis can be present at birth or develop from a strong preference to look in one direction. Babies with torticollis are more likely to develop plagiocephaly than other babies, since they always rest on the same spot on the back of their head.
Premature infants and those that have to spend time in the NICU after birth are also more likely to develop plagiocephaly. This is because their skull bones are softer than the skulls of babies born at full term. They also tend to move their heads less often. In very premature babies, soft skull bones can result in dolichocephaly (DOLL-ee-koe-SEF-uh-lee), or a long and narrow head.
Symptoms of Positional Plagiocephaly
A baby with positional plagiocephaly has flatness on the back of one side of the skull (asymmetric). This happens when babies tend to rest on one side more than the other. Or, flattening can develop across the middle of the back of the head (symmetric) if that is where your baby always lies. This is referred to as brachycephaly. If you think your infant has positional plagiocephaly, please talk to your child’s doctor or nurse practitioner about it.
In most cases, only the back of the head is affected but sometimes the forehead and facial structures are also uneven.
Positional Plagiocephaly Diagnosis
To diagnose this condition, your child’s doctor or nurse practitioner will examine your child’s head. Positional plagiocephaly can sometimes look like a condition called craniosynostosis. These two conditions need very different kinds of treatment. The team at Scheck & Siress are skilled in looking for the signs that help us tell these two conditions apart.
Positional Plagiocephaly Treatment Options
Treatments range from a simple repositioning and increased tummy time, to physical therapy, to more involved treatment with a helmet for children under the age of 18 months.
If your child has positional plagiocephaly and is less than 4 months old, the first step is to attempt a repositioning program, as directed by your healthcare team. Insurance requires these attempts be made before they consider covering a helmet.
If your baby has torticollis, your baby’s healthcare team will recommend exercises or a referral to a physical therapist. Exercises will help improve your baby’s Range of Motion, allowing them to move their head in all directions. If your baby has developmental delays, your child’s doctor or nurse practitioner will talk to you about what evaluations or therapies could be helpful.
If repositioning and therapy do not work to improve positional plagiocephaly, your child’s pediatrician or nurse practitioner might recommend other treatments. Moderate and severe positional plagiocephaly may be treated with a remolding helmet. Helmets treat your baby’s uneven head shape by gently redirecting growth into a normal shape. Helmet use is usually started after 6 months of age, but can be effective for infants from 4 months up to 18 months. Your baby will wear the helmet about 23½ hours each day.
The length of treatment varies, depending on how severe the plagiocephaly is, and on the age of your child. Typically only one helmet is necessary to correct the head shape, and on average, an infant will need to wear the helmet 3-6 months. The best results are seen when a helmet is started before 9 months of age.
Your orthotist will take many measurements and factors into consideration before suggesting a helmet.
If your child’s doctor or nurse practitioner has detected plagiocephaly they will prescribe further evaluation by an orthotist or specialist. We have orthotists at 13 of our 15 locations that are certified to treat plagiocephaly.
The team at Scheck & Siress will do a comprehensive evaluation and take several measurements before suggesting a helmet.
We can capture an image of your child’s head to make a helmet 3 different ways:
- STARscanner™ Laser Data Acquisition System – This state-of-the-art technology replaces the need for plaster casting. Instead it uses non-contact laser scanning technology to obtain precise measurements in less than 2 seconds.
- STARscanner is available at our Schaumburg location.
- The SmartSoc™ 3D Capturing System – This revolutionary clinically proven technology converts 2D video into a 3D model.
- SmartSoc™ 3D Capturing System is available at these locations:
To prevent problems with plagiocephaly, when your baby is awake, give your baby active “tummy time.” Find ways for your baby to play and move while they are on their tummy, several times each day. Choose different positions and ways for babies to play and be held. When you lay your baby down to sleep in the first few months, alternate the direction the head faces each night.
It is OK to use strollers, infant seats, car seats, cribs, bassinets and play pens when necessary. But keep in mind that babies need a lot of active play times and chances to move that do not only happen while sitting in one position. Play with babies to get them moving. Encourage crawling, reaching, rolling, pulling, pushing, holding and grasping.