Helping Children with Abnormal Head Shape

Positional plagiocephaly is a term used to describe an abnormal head shape. Flattening along one side of the back of the head occurs. This flattening is usually the result of pressure being applied to an infant’s developing skull. For instance, if a child prefers to look one direction, the corresponding side of the back of the head may become flattened. Facial asymmetries also can occur. Plagiocephaly can be caused by in utero positioning, multiple births, prematurity, torticollis, prolonged positioning on the back, or from extended positioning time in carrier seats/car seats.

The overall incidence of plagiocephaly has increased since 1992 when the “Back to Sleep” program was initiated to decrease the risk of sudden infant death syndrome (SIDS). The Back to Sleep program has been successful in reducing the number of SIDS deaths. It has, however, resulted in more cases of plagiocephaly. In order to keep babies safe while sleeping, while promoting good head shapes, we recommend “Back to Sleep, Belly to Play.” Belly time should always be supervised.

In addition to plagiocephaly, another common positional head deformity is brachycephaly. Brachycephaly is flattening of the entire back of the skull. The skull appears very wide. Brachycephaly tends to be common in children who have had prolonged positioning on their backs or in infant carrier seats/car seats.

Both plagiocephaly and brachycephaly can be successfully treated. Initially, the physical therapist will assess an infant to rule out tightness in the neck muscles. Skull measurements will be taken. A positioning program will be given to the family. If positioning is unsuccessful, the therapist may recommend a cranial orthotic or band.

Plagiocephaly and brachycephaly must be treated early for the best results as the skull shape can change until around 18 months of age. Any abnormal head shape noted after six weeks of age should be assessed by a physician. If the physician feels the head shape is of concern, a prescription for physical therapy would be recommended.