Care Management
The care management team at Shriners Children's consists of registered nurses and social workers who act as resources for families throughout their plan of care.
Plagiocephaly
Plagiocephaly, commonly referred to as "flat head," is a condition in which an infant's head develops a flat spot or is misshapen.
This condition typically arises when a baby's soft skull remains in one position for extended periods, leading to an asymmetrical head shape. It usually affects one side of a baby's head.
Plagiocephaly can be diagnosed by a primary family physician or a specialty provider. It is ideal to begin treatment for these conditions as early as possible.
It is common for babies who have torticollis, a condition with tightened or shortened neck muscles, to also have plagiocephaly.
Diagnosis of Plagiocephaly
At your first appointment at Shriners Children's, our team of medical providers will do a detailed examination of your child to determine a plan of care. This evaluation may involve:
- A physical examination of your child's head shape.
- Assessment of neck muscle function, including neck range of motion and strength, to determine if your child has torticollis.
- Cranial evaluation measurement and photos with our Pediatric Orthotic & Prosthetic Services (POPS) team.
- Discussion of medical or environmental variables contributing to torticollis or head shape.
- In some cases, imaging (X-rays or CT scans) may be utilized to rule out craniosynostosis, a condition where skull bones fuse prematurely that typically requires surgery.
Treatment of Plagiocephaly
Sometimes plagiocephaly may correct itself, but it can also get worse if it is not treated. Potential treatment of plagiocephaly at Shriners Children's can include:
- Physical therapy to treat torticollis and strengthen neck muscles. Your child's physical therapy plan will be customized by our rehabilitation team.
- Helmet therapy, otherwise known as cranial remolding therapy. Custom helmet orthoses are fit in-house through our POPS department. The duration of helmet therapy treatment will vary based on your baby's needs, but the average treatment is 3-5 months.
Specific treatments and services may vary by location. Please contact a specific location for more information.
Types of Head Deformity
Plagiocephaly: The most common type, referred to as flat head, and is sometimes called positional or deformational plagiocephaly. This type causes your baby to have flattening on one side of their head.
Brachycephaly: This type causes a flattened appearance on both sides of the back of your baby’s head, creating a wide head shape. The flattening may be symmetric or asymmetric.
Dolichocephaly: This type causes flattening on the sides of the head, giving your baby’s head an elongated, narrow shape. Dolichocephaly characterized by a boat-shaped head with premature fusion of certain skull sutures. This type is common in premature babies who spend time in the neonatal intensive care unit.
Craniosynostosis: This type is a rare, serious birth defect. When the fibrous joints between the bones of your baby’s skull (cranial sutures) prematurely close, it causes a deformity.
Scaphocephaly, also known as sagittal craniosynostosis, occurs when the sagittal growth plate of your baby's skull closes before birth. It causes abnormal growth of the brain and skull (the skull becomes long and narrow), and developmental disabilities in some children. Surgery is the main treatment and is effective at restoring the shape of the head. Most children receive surgery before the age of one.
There are several other types not explained on this page. For a specific diagnosis for your child, please schedule an appointment.
What causes plagiocephaly?
A baby's skull is soft and somewhat moldable. Several factors can contribute to the development of plagiocephaly. It can occur while your baby is growing in the uterus and can also develop after birth.
- In Utero: There are multiple possibilities for your baby's head to be flattened before birth:
- The baby's head may rest against a flat surface in utero.
- Pregnancy with multiples may make the babies crowded and can cause flattening.
- A uterus being too small or misshapen.
- Unusual fetal positioning inside the uterus.
- A uterus that contains too little amniotic fluid.
- Laying Position: Infants who consistently lay on their backs without varying head positions may develop flat spots due to prolonged pressure on one area of the skull.
- Torticollis: A condition where neck muscles are tight or shortened, causing the baby's head to tilt to one side and rotate to the opposite side, can limit head movement and contribute to uneven skull shaping.
- Premature Birth: Premature infants often have softer, less developed skulls and may spend extended time in neonatal intensive care units on their backs, increasing the risk of developing flat spots.
- Lack of "tummy time"
Signs and Symptoms
Signs of plagiocephaly include:
- A flattened area on the back or side of your baby's skull, giving their skull an uneven or irregular shape.
- Misalignment of the ears, with one ear appearing pushed forward.
- Asymmetry in facial features, such as uneven cheekbones or eye shape.
Due to the flattening, your child may naturally rest their head on the flattened area, causing the condition to get worse if not treated. It's important to note that plagiocephaly does not affect brain development or affect your baby's health.
Other Treatment Options
In addition to physical therapy and prior to helmet therapy, there may be some treatment options that you can try at home through repositioning.
- Change your baby’s sleep position often: If you place your baby’s head at the top of the crib one night and the bottom the next, your baby may look different ways each time.
- Change your baby’s head position while they sleep: While your baby sleeps, gently move their head to the side they don’t usually favor.
- Hold your baby often: This limits the time your infant spends leaning against a flat surface. Cradle and feed your baby in different positions, switching arms from time to time. Let your baby lie on your chest.
- Provide lots of supervised “tummy time” while your baby is awake: Tummy time improves flat head syndrome and strengthens your baby’s neck, arms and back.
- Reduce sleeping time in places where your baby’s head can’t move freely: Avoid too much time in curved baby swings or car seats that restrict movement.
- Strategically attract your baby’s attention: A mobile or other safe toy outside their crib may encourage your baby to turn and look.
Why Treatment Matters
Plagiocephaly treatment matters because early evaluation (around 3 months of age) can help ensure proper head shape development, improve neck mobility, and prevent potential complications. While plagiocephaly is primarily a cosmetic issue and does not affect brain development, untreated cases can lead to:
- Persistent Skull Asymmetry: Without treatment, flattening may remain noticeable as the child grows, potentially affecting facial symmetry.
- Neck and Muscle Imbalances: If associated with torticollis, limited neck movement can lead to delays in motor development.
- Fitting Issues for Helmets or Glasses: In severe cases, head asymmetry can make it difficult to wear helmets, glasses, or other headgear properly.
Early treatment, such as repositioning techniques, physical therapy, or cranial remodeling orthoses (helmet therapy), can help correct skull asymmetry and support typical development. Shriners Children's provides specialized care to ensure the best possible outcomes for children with plagiocephaly.
When we found out our son had some challenges with his head shape, we researched and learned that Shriners Children's had a great program, and we've been working with amazing professionals ever since.
Locations that Treat Plagiocephaly
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Shriners Children's provides specialty healthcare to children around the world. We offer a comprehensive range of treatments, services and support to improve the quality of our patients’ lives and help them reach their full potential.
Shriners Children's Offers Custom Helmet Therapy
Newborn babies’ skulls are made of soft plates with spaces between them. As a baby grows, these plates grow, gradually hardening and coming together. Shriners Children’s uses a cranial remolding orthosis to provide appropriate resistance over the rounded areas so that the natural brain and skull growth are directed into the areas of flattening.
Services We Provide
Child Life Services
Child life professionals at Shriners Children’s take pride in focusing on the "above and beyond" aspects of medical care for our patients. From procedure support to camps, they are ready to advocate for your family.
Pediatric Orthotic and Prosthetic Services (POPS)
Shriners Children’s Pediatric Orthotic and Prosthetic Services (POPS) designs, fits and manufactures orthotics and prosthetics for children from infants to young adults.
Next Steps
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