What Is Plagiocephaly? Signs, Causes, and Treatment for Babies
Quick Answer: Plagiocephaly is flattening on one area of a baby's head that creates an asymmetrical skull shape. It's common and is highly treatable with early physical therapy intervention. Most cases improve significantly when treatment starts before 4 months of age. Look for flat spots on the back or side of the head, asymmetrical ear positioning, or a preference for looking in one direction.
If you've noticed a flat spot developing on your baby's head, asymmetrical ear positioning, and your baby consistently turning their head to one side, your baby may have plagiocephaly. This condition is more common than many parents realize and is treatable with early intervention.
What Is Plagiocephaly and Why Does It Happen?
Plagiocephaly means "flat head" and refers to asymmetrical head flattening that occurs because babies' skulls are soft and moldable. Positional plagiocephaly develops when babies spend too much time in one position, causing pressure on specific areas of the skull.
Consistently placing babies in the same position, excessive time in car seats or carriers when not traveling, and limited tummy time can all contribute to skull flattening. Some babies also develop plagiocephaly from torticollis (neck muscle tightness) that causes them to prefer looking in one direction. An increase in positional plagiocephaly began in the 1990s when safe sleep campaigns started recommending back sleeping to prevent SIDS. While this has dramatically reduced SIDS deaths, it has led to more flat head concerns.
Skull flattening is external and doesn't affect brain development or intelligence, but the underlying muscle imbalances can affect other aspects of development if left untreated.
Understanding the cause helps guide treatment, but regardless of the origin, early physical therapy intervention is the most effective approach.
How Do I Know if My Baby Has Plagiocephaly?
The most obvious sign is visible flattening on the back or side of your baby's head, which you might notice when looking down at your baby from above or when running your hand over their head. You may also notice asymmetrical ear positioning, where one ear appears more forward than the other.
Other signs include one side of the forehead being more prominent than the other, and your baby showing a preference for looking in one direction or having difficulty turning their head fully to both sides.
Some babies also show asymmetrical movement patterns, such as always reaching with one arm more than the other, rolling preferentially to one side, or resistance when you try to move their head to the non-preferred position. These signs often become more noticeable as babies become more active around 6 to 8 weeks of age.
What's the Connection Between Plagiocephaly and Torticollis?
Plagiocephaly and torticollis (neck muscle tightness) commonly occur together. This happens because neck muscle tightness causes babies to consistently position their heads in ways that create pressure on specific areas of the skull.
The relationship works both ways. Sometimes torticollis develops first and causes head flattening, while other times positional preferences lead to both muscle tightening and skull flattening simultaneously. This is why both conditions are often treated together in physical therapy.
Addressing any underlying torticollis is crucial for successful plagiocephaly treatment, while treating head flattening often requires addressing movement patterns and positioning preferences for optimal results.
When Should I Seek Help for My Baby's Plagiocephaly?
Current guidelines recommend seeking evaluation as soon as you notice signs of head flattening. Early intervention leads to better outcomes and can often prevent the need for more intensive treatments like helmet therapy.
Contact your pediatrician or request a pediatric physical therapy evaluation if you notice any flattening on your baby's head, asymmetrical ear or facial features, consistent head turning preferences, difficulty turning the head to both sides equally, or resistance to certain positions during daily activities.
Don't wait to see if it improves on its own. While some very mild cases may improve naturally, moderate to severe plagiocephaly typically requires professional intervention, and starting treatment early significantly improves outcomes.
How Is Plagiocephaly Treated?
Physical therapy is the initial treatment for plagiocephaly. As a pediatric physical therapist, I use specific techniques tailored to your baby's individual needs.
Treatment includes repositioning strategies to reduce pressure on flattened areas, exercises to address any underlying torticollis or neck muscle tightness, and positioning activities that encourage movement in all directions. I also teach parents environmental modifications and home strategies to support treatment between sessions.
The treatment approach is always gentle and developmentally appropriate for your baby's age and tolerance. Sessions typically involve play based activities that encourage natural movement while addressing the positioning patterns and muscle imbalances contributing to head flattening.
For more severe cases or those that don't respond adequately to conservative treatment, helmet therapy may be recommended.
What Happens if Plagiocephaly Isn't Treated?
While plagiocephaly doesn't affect brain development or intelligence, leaving significant flattening untreated can lead to permanent changes in head and facial shape. Severe cases may result in noticeable facial asymmetry, including uneven eye positioning, asymmetrical jaw development, and differences in ear alignment.
These changes can affect glasses fitting, helmet fitting for sports, and some children may experience self consciousness about their appearance as they get older. In rare cases, severe plagiocephaly can affect jaw development enough to impact chewing or dental alignment.
Untreated plagiocephaly can also affect overall development. Babies may continue to show movement preferences that can impact skills like rolling, sitting, or crawling due to persistent asymmetrical movement patterns.
Early intervention prevents these complications and ensures your baby develops normal head shape and movement patterns during the critical period when the skull is most moldable.
When Are Helmets Recommended?
Helmet therapy is considered when moderate to severe asymmetry persists despite 2-3 months of consistent PT and positioning efforts, when cranial measurements show moderate to severe deformation, when the baby is between 4-12 months old (optimal age for helmet effectiveness, earlier the better), when facial asymmetry is developing alongside skull flattening, or when there's minimal improvement with conservative treatment.
The helmet decision process follows this progression: early PT assessment, 2-3 months of PT with positioning and exercises, progress evaluation to determine if improvement is sufficient, and specialist consultation only if minimal improvement occurs with severe asymmetry persisting. Helmet fitting is considered only after conservative treatment has been tried.
Most babies with plagiocephaly respond well to early PT intervention, but for those who do need helmets, they can be very effective when used appropriately and combined with continued PT.
The Bottom Line
Plagiocephaly is a common and highly treatable condition when addressed early. The head flattening and asymmetry that parents notice are signs that professional evaluation is needed, not something to wait and see about.
Early physical therapy intervention is effective, with most babies achieving significant improvement when treatment begins before 4 months of age. The key is recognizing the signs early and seeking professional help promptly rather than hoping it will resolve on its own.
If you notice any signs of plagiocephaly in your baby, don't hesitate to seek evaluation. Early intervention prevents complications and ensures your baby develops normal head shape and movement patterns during the critical period when these changes are most possible.
Frequently Asked Questions About Plagiocephaly
Q: Is plagiocephaly painful for my baby? Most babies with plagiocephaly don't appear to be in pain from the head shape itself, but they may show discomfort when positioned in ways that challenge their preferred patterns or if there's underlying neck muscle tightness.
Q: Will my baby's plagiocephaly affect their development? The head shape itself doesn't affect brain development, but the underlying movement patterns that contribute to plagiocephaly can impact other aspects of development if not addressed.
Q: How much tummy time does my baby need? Start with short periods several times daily, working up to about 30-60 minutes total per day by 4 months of age, spread throughout supervised awake time. Your physical therapist will provide specific guidance based on your baby's tolerance and needs.
Related Reading
What Is Torticollis? Signs, Causes, and Treatment for Babies
P.S. This information is for educational purposes only. It is not medical advice and is not a substitute for skilled physical therapy intervention. While I am a physical therapist, I am not your child's physical therapist. If you have questions or concerns about your child's health and/or development, please contact your pediatrician.
