Positional Plagiocephaly Prevention and Treatment

Baby girl with wide eyes and open mouth
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The American Academy of Pediatrics' Back to Sleep campaign, in which children are put to sleep on their backs, has dramatically decreased the number of SIDS deaths since it was begun. Unfortunately, one consequence of this practice has been the increase in cases of positional plagiocephaly or infants with flat heads.


It is not hard to diagnose or recognize a child with positional plagiocephaly, which is also called posterior or deformational plagiocephaly and is usually first noticed when an infant is about 2 to 3 months old.

These children will have flattening on one side of the back of their head and unlike craniosynostosis, they will also have a compensatory bulging or bossing of their forehead on the same side of their head.

Their ear will also likely be pushed forward on that side of their head. Keep in mind that it is easiest to see all of these changes when looking at a child's head from above.

Although usually not necessary, additional testing can be done if the diagnosis is not clear, especially if your pediatrician suspects lambdoid synostosis, a form of craniosynostosis. This testing may include a skull X-ray or a head CT, which is better than a plain X-ray in detecting if the sutures of the skull are still open and to rule out lambdoid synostosis.


Since posterior plagiocephaly is caused by there being too much pressure being put on one part of your infant's head, you can often prevent it from occurring by alternating the positions that your infant stays in.

This does not mean that you should stop putting your child to sleep on their backs, but you can alternate your child's head position each time you put them to sleep.

Spending more time on the stomach (prone position) in tummy time when your baby is awake and being supervised is also a good idea. And try to avoid letting your infant spend a lot of time in the same position on their back when they're awake. This may mean avoiding leaving your infant in car seats when not in a car and bouncy type seats for long periods of time. An infant sling or wrap can be a better alternative, as they put less pressure on your child's head, or use a stationary walker once your child is old enough to sit in one.

These preventative measures can be especially important for infants at higher risk of positional plagiocephaly, including preemies, multiples, and infants with poor muscle tone.

When should you start? Usually during the newborn period, when an infant's skull is maximally deformable.


At first, the treatment of posterior plagiocephaly is the same as the preventative measures already discussed and include measures to keep your infant off the part of his head that is already flattened. Tummy time, alternating head position while sleeping on their back, and spending minimal time lying on their backs while awake can help most children with flat heads.

Improvement usually occurs over a 2 to 3 month period. If you do not see improvement or the deformity continues to worsen, then your child will likely need an evaluation by a pediatric craniofacial surgeon or a pediatric neurosurgeon.

Although surgery is rarely needed, the specialist might recommend that a skull-molding helmet or band be used.

Special attention should be made to infants with torticollis, as they often also need neck exercises as part of their treatment. These children often keep their heads in the same position and have trouble turning their heads and neck. Neck exercises, perhaps with the help of a pediatric physical therapist, can help these children.

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