Children & families · Conditions
Positional plagiocephaly (flat head)
Flattening of a baby's head from lying in one position. It is normally not treated with surgery; repositioning, tummy time and physiotherapy usually help, with helmet therapy for selected babies.
What is it?
Positional (deformational) plagiocephaly is flattening of part of a baby's head, usually at the back on one side, caused by pressure from lying in the same position. It has become more common since babies are advised to sleep on their backs, which remains the safest way for babies to sleep. When the whole back of the head is flattened, it is called positional brachycephaly. The skull joints are open and the brain is not affected.
What symptoms can it cause?
The head looks flat on one side at the back. Seen from above, the head often has a parallelogram shape: the ear and forehead on the flat side are pushed slightly forward. Some babies have a tight neck muscle (torticollis) and prefer to turn their head to one side. It usually becomes noticeable in the first weeks or months of life.
How it differs from craniosynostosis: in craniosynostosis a skull joint has fused, and the head shape tends to be present from birth or early on and does not improve with repositioning. In lambdoid synostosis, the rarer fused-joint cause of flattening at the back, the head tends to look more like a trapezoid from above, with the ear on the flat side pulled backwards rather than forwards. A doctor can usually tell the two apart on examination.
How is it assessed?
Your baby will be examined, the head shape looked at from above and measured, and the neck checked for torticollis. Scans are usually not needed; imaging is reserved for when the examination suggests craniosynostosis.
What are the treatment options?
Positional plagiocephaly is normally not treated with surgery. Treatment includes:
• Repositioning: alternating the direction your baby's head faces when sleeping on the back, and when feeding and carrying, so that pressure is taken off the flat side.
• Supervised tummy time when your baby is awake, which strengthens the neck and takes pressure off the back of the head.
• Physiotherapy, particularly for babies with torticollis.
• Helmet (cranial orthosis) therapy for selected babies with moderate or severe flattening that has not improved, usually started between about four and six months of age, when the skull is still growing quickly. The practice works with a network of orthotists who can assess your baby and provide helmet therapy when it is indicated.
When might surgery be considered?
Surgery is not used for positional plagiocephaly. If the examination or the course of the head shape suggests craniosynostosis instead, that is assessed separately.
What to expect from recovery and follow-up
Most babies improve over months as they grow, gain head control and spend less time lying on their backs. Some mild flattening may remain but is usually hidden by hair. Your baby may be reviewed in clinic to check progress, and helmet therapy, if used, is monitored by the orthotist.
When to seek urgent help
Positional plagiocephaly does not cause an emergency. If your child is very drowsy, difficult to wake, has a seizure, repeated vomiting or a severe headache, go to the nearest emergency unit or call 10177. If your child is under our care, also call the hospital switchboard and ask for Dr Labuschagne (Netcare Unitas Hospital 012 677 8000; Nelson Mandela Children's Hospital 010 133 0600).
This page is general information for parents and caregivers. Your child's doctor will advise on what applies to your child.