Positional Plagiocephaly

What is Positional Plagiocephaly?

The bones of a newborn’s skull are very soft and malleable, making them susceptible to flat spots on the head. Flat spots may be present at birth or can quickly develop within the first 4 months of life.

Positional plagiocephaly specifically refers to flattening to the back of the

head on one side, leading to asymmetry in head shape.

Flat spots may also result in one ear being shifted forward compared to the other, prominence of one side of the forehead, or an appearance of fullness in one cheek.

Positional plagiocephaly is a cosmetic condition, this type of flattening will not affect a baby’s brain growth or development.

What Causes Positional Plagiocephaly?

Flat spots can develop on your baby’s head for many reasons.

Head shape may be affected by positioning in the womb or during the birthing process. Other causes of flat spots after birth can be attributed to pressure applied to the head.

Babies spend a lot of time sleeping, and sometimes they develop a flat spot from the many hours they spend laying down. For the first 6 months, the safest sleep position for babies is on their backs.

Flat spots can also be caused by spending more time in car seats, strollers, bouncy seats, and swings.

Some babies also have tight neck muscles at birth, called Congenital Muscular Torticollis, which makes turning their head difficult. This neck tightness can result in your baby having a preference for turning their head one way which can lead to development of a flat spot on the head if they are always turned to one side.

Since babies also have weak neck muscles, this preference for turning one way can lead to a more severe flat spot if not properly addressed, and the neck tightness can also worsen.

Signs of Positional Plagiocephaly

• The back of your baby’s head is flatter on one side than the other

• When looking down on their head, you may notice on ear is more forward than the other

• You may notice your baby has a bit of a bulge on their forehead

• In more severe cases, you may noticed facial asymmetry, giving the appearance one eye is larger or one cheek is fuller.

How is Positional Plagiocephaly Diagnosed?

A pediatric physical therapist or pediatrician can do a thorough physical evaluation of your baby’s head and neck to determine the type and severity of flattening of your baby’s head.

They can also assess for any contributing factors such as neck tightness. During the evaluation, they can determine if the abnormal head shape is the result of a more serious condition called Craniosynostosis.

This condition requires further medical evaluation as it involves the premature fusion of the bones of the skull (cranial sutures), which can restrict proper brain growth and development.

How can Positional Plagiocephaly Be Treated?

• Limit time spent in baby equipment such as swings, bouncy seats, strollers, and car seats, when possible

• Ensure safe sleep practice by always placing your baby to sleep on their back

• Repositioning their head to the other side when placing them down to sleep can help reduce pressure to their flat spot

• Practice tummy time when awake to offload the flat spot

• Alternate your holding position when carrying your baby to reduce pressure to the flat spot

Babies often experience neck tightness as well as positional plagiocephaly, physical therapy can help by providing stretches and strategies to implement at home to address both concerns.

Early Detection

Early detection is key to help treat head shape concerns and neck tightness.

If you are noticing a flat spot develop or your baby has a preference for looking to one side, pediatric physical therapy can help address these concerns and provide a home exercise program to support your baby’s head and neck as they grow.