Plagiocephaly: 10 Things You Need to Know

As a mom and occupational therapist with a child that had positional plagiocephaly, this topic is very dear to my heart. My purpose behind this article is to raise awareness in the treatment and prevention of plagiocephaly. New parents need to be educated on three things: 1) the occurrence of plagiocephaly, 3) how to prevent plagiocephaly, and 2) the options available to fix plagiocephaly without a cranial helmet.

Download our free “flat head” guide here to learn more about preventing & correcting “flat head” with your baby.

Plagiocephaly is a very hot topic, as many celebrities and icons are placing their infants in cranial helmets due to head shape changes in their baby. Plagiocephaly is defined by the changes in head shape on one side of the head, either the right or the left. This is caused by prolonged pressure on one side when a baby lays on their back. This often presents in infants with torticollis, or side preferences, in which the baby lays on one side of the head more than the other. This can develop very quickly and I want to provide you with a list of 10 Things You Need to Nnow About Plagiocephaly.

#1: Plagiocephaly is the flattening of one side of the head

Plagiocephaly is defined as flattening on one side of the head due to prolonged pressure from a surface. This is often due to a baby’s sleeping position and presents as one side of the head appearing “more round” than the other. The flattening of one side causes bulging of the other due to the redistribution of mass. If you think of a baby’s head like a balloon, plagiocephaly is just a shift in “air". The shifting of “air” from a contact with a surface, results in the flattening on one side if the baby prefers one side over the other. When assessing plagiocephaly, it’s important to view your baby from the very top, or a bird’s eye view. This ensures that a proper assessment can be made when comparing one side to the other. If flattening is present, one side may look larger, or more “round” than the other. See the photo on how to view your baby’s head to indicate if plagiocephaly is present. A good rule of thumb is to divide the image down the middle from the level of the nose and compare the two halves. I am also happy to assess your baby’s head through a free evaluation if interested!

#2: Babies that sleep on their back are at a higher risk for plagiocephaly

Back to sleep, which was introduced in the late 1990s, encouraged parents to place babies on their back to reduce the risk of Sudden Infant Death Syndrome (SIDS). Although back to sleep has significantly lowered the risk of SIDS, back sleeping significatly increases the risk of plagiocephaly. This is due to the constant pressure on the back of the head. It’s a good lesson in physics - a baby’s head is very soft so when they sleep on their back, pressure is applied to those soft areas. This can cause a shift in mass (as discussed above), so flattening on the side of the head can occur if baby sleeps on one side every night. This can also occur is baby favors that side in other areas they lay. Be sure to monitor your baby’s sleeping position when they are on their back and avoid baby sleeping on the same side every night. Interested in seeing if your baby is at risk for plagiocephaly? Take this quiz!

#3: 1 in 10 babies are affected by plagiocephaly

As discussed above, The Safe to Sleep initiative strongly encouraged parents to place babies on their backs to sleep to minimize the risk of SIDS (Sudden Infant Death Syndrome). Although the risk of SIDS has gone down significantly (which is SO IMPORTANT), the risk of plagiocephaly has increased. Read more about the rise in plagiocephaly here. This is not necessarily a bad thing, but a topic that needs to be prioritized when discussing the many things to prepare for when bringing a new baby home. New parents are strongly encouraged to place their baby on their back to sleep, so they should be strongly encouraged to monitor their baby’s head shape and implement strategies to prevent plagiocephaly. A baby that sleeps on their stomach is not placing pressure on the soft areas of the head. Although back sleep is THE SAFEST POSITION, preventing plagiocephaly must be a topic of conversation with new parents. This brings me to the next thing you need to know about plagiocephaly.

Download our free “flat head” guide here to learn more about preventing & correcting “flat head” with your baby.

#4: Preventing plagiocephaly is something every parent should be aware of

Preventing plagiocephaly can significantly reduce the risk of your baby developing flattening on one side of their head. Preventing sounds simple right!? Take recurrent pics of your baby’s head every other week, make sure they don’t lay on one side of the head more than the other, etc… But, it’s really more complex than that. Preventing plagiocephaly not only involves those things, but also many more. Preventing plagiocephaly involves strategies positioning, stretching, strengthening, monitoring, and whole body stretches. Positioning includes making sure your baby does not spend a prolonged amount of time on one side of their head at any given time. Babies tend to do 7-9 activities recurrently throughout the day, so it’s important to monitor their head position during all of these activities. Stretching is also important in preventing plagiocephaly. The presence of plagipcephaly often indicates neck muscles imbalances (see point #5 for more information), so stretching your baby’s neck is very important in reducing the risk of plagiocephaly. Download my Neck Stretches to Prevent and Correct “Flat Head” for more information. Neck tension can also lead to full body tension, so it’s very important to stretch your baby’s whole body to prevent plagiocephaly and also milestone delays. Lastly, strengthening your baby’s neck will ensure that the muscles are balance and baby can turn and move head in all directions equally. This will leads to equal distribution of pressure and NO PLAGIOCEPAHLY. YAY! Plagiocephaly develops quickly, so be sure to monitor your baby’s head shape by taking photos every couple weeks. See my course here for more information on how to prevent plagiocephaly in your baby!

#5: Plagiocephaly is often due to muscle imbalances

As stated above in point #3, plagiocephaly is often due to muscles imbalances. When a baby is in-utero, they are very crowded and have limited areas to move, stretch, and reposition. Once a baby is born, they exhibit a synergistic flexion pattern where they keep all of their limbs in a bent position. When a baby is placed on their back to sleep, they are able to maintain this flexion pattern, and may not move or elongate their body very much. This may lead to tension in the neck and whole body. When a baby is placed on their belly to sleep, the arms are often up in an extension pattern and the head is rotated one way or another. This leads to a prolonged stretch of the neck and upper body, which leads to less body tension. Placing a baby on their back to sleep is THE MOST SAFE POSITION, but when doing so we should offer our babies a stretch of the neck and body to avoid muscles imbalances and tightness. When a side preference develops, a baby maintains their head turned to one side. This leads to muscle strength imbalances in the neck, so a favored side is only encouraged. This favoring of a side leads to tightness and increase strength on one side of the neck, which leads to a significant increase in plagiocephaly. This is why it’s very crucial to address neck and body tension, as well as neck strength when preventing and correcting plagiocephaly. Does your baby exhibit a side preference when sleeping on lying down? Submit a form here for a FREE head shape assessment, so if any flattening is present you can begin correcting ASAP.

#6: Early detection of plagiocephaly often occurs at the 2 and 4 month checks

When your baby is born, you are so excited to take them home and begin your life as a parent. Shortly after returning home, you will schedule your baby’s check in at the pediatrician, or family doctor’s office. This appointment, in the United States, often occurs at the 2 month mark. This is the first time, unless otherwise indicated, your baby visits to pediatricians office for a “well check". At this check, many measurements are taken, including head circumfrence. The pediatrician will also check your baby’s head shape, from a bird’s eye view (as discussed above) and a profile view. This check may indicate flattening on one side of the head if the baby has a favored side is present. Your doctor may suggest more tummy time and may revisit the flattening, if present, at the next visit. If flattening is still present at the 4 month check, your doctor may recommend physical or occupational therapy or conservative treatment for the flattening. Helmet referrals are often made at the 4 month check, but they are not the only option in correcting plagiocephaly. More on this topic in point #10. If your pediatrician has indicated flattening of your baby’s head, I am happy to take a look and help you navigate next steps through a free head shape evaluation here.

#7: Plagiocephaly is measured through CVA and CVAI

Plagiocephaly measurements are taken to rate the severity of the differences in sides to determine best treatment of the asymmetry. When measuring plagiocephaly, CVA and CVAI can be taken manually or through a 3D scanner at a cranial orthosis clinic. CVAI is the gold standard in plagiocephaly measurements and determines the amount of asymmetry in regards to the individual baby’s head size. Refer to the chart for specific measurements of CVAI and their rating category. Also, read the recent research study completed at Children’s Healthcare of Atlanta (CHOA) on the evidenced around these measurements. This article also states 3 mm of asymmetry relating to CVA is considered normal, but this measurement standard is not backed by evidence. As far as CVA is concerned, I have a trusted orthotist colleague and the measurements she uses to guide her judgement are as follows: normal = 0-5 mm, mild = 5-10 mm, moderate = 10-15 mm, severe = 15+ mm. Read a recent blog post regarding Head Shapes and Helmets where I chat with this trusted orthotist, Becki, who specializes in infant cranial helmets.

#8: Certain baby gear leads to increased risk of plagiocephaly

There is a TON of baby gear on the market, most things functional for new or seasoned parents. But, there are certain baby gear options that can increase your baby’s risk for plagiocephaly. A few of these items include the Snoo bassinet, Merlin Sleep sack, weighted sleep sacks, swings, bouncers, and overhead play gyms. These items encourage baby to stay in one position, on their back, which is the safest sleeping position but we do not want these items to hinder baby’s movements. We want baby to move freely and reduce constant pressure on any one area of the head, and these items do not encourage that. Although the Snoo is great for soothing and keeping baby on their back, the included swaddle does not allow baby to move freely. Additionally, the Merlin sleep suit is wonderful for encouraging independent and long windows of sleep, but the suit does not place baby in a nature resting position. This resting position, that the suit encourages, may not allow free movement. Weighted sleep sacks can be thought of similarly to the Merlin suit as this weighs baby down and does not encourage natural, free movement and repositioning. Containers and swings may be used in moderation if needed, but it’s very important to be mindful of baby’s head position in these places. This can lead to plagiocephaly very quickly if not monitored. Lastly, a play gym is wonderful for visual input and hand exploration but while baby is mesmerized with the toys above head, they are not motivated to move and reposition themselves. When thinking of baby gear and plagiocephaly prevention, think items that 1) allow free movement and 2) avoid constant pressure on the head.

#9: Some babies are at a higher risk for plagiocephaly

Some babies are at a higher risk for plagiocephaly and that is okay! We just have to be mindful of this and be proactive in preventing this from occurring in our infants. Babies that are at a higher risk for plagiocephaly includes, but are not limited to, breeched babies, multiple births, pre-term infants, and babies born of small, petite women. Breeched babies are very crowded in utero, which may lead to increased tension and tightness in their body. This can lead to a side preference or torticollis, which can lead to plagiocephaly. Multiple births can also lead to plagiocephaly due to in-uterine crowding and difficulty repositioning. The parent to multiple babies is also busy and may have difficulty making time to monitor the head shape. We all know one baby keeps us BUSY, but what about more than one!? Pre-term infants are also higher risk for plagiocephaly due to more time spent on their back after birth. A baby born pre-term may spend 3 or more weeks lying on their back to sleep compared to a full term infant. No wonder plagiocephaly may occur more easily, due to the constant and increase amount of time on the soft skull. Lastly, what I have found from my experience, is plagiocephaly is more common in babies who have a small, petite mother. If the mother is small, the uterus may not allow optimal room for baby to move and reposition. This difficulty with repositioning can lead to in-uterine crowding and tightness in the body once baby is born. It’s so important, in all of these cases to prioritize preventing plagiocephaly from day one.

#10: Helmets are not the only way to correct plagiocephaly

I am saving the BEST FOR LAST. If you know me, you know I am so passionate about keeping babies out of helmets and raising awareness around preventing and correcting plagiocephaly. Helmets are a popular option when correcting plagiocephly, but they are not the only option. I have created a very strict program for correcting plagiocephaly without a helmet through repositioning, stretching the neck and the whole body, and addressing any muscle imbalances present. The research shows that babies with mild to moderate flattening, in all ages of infancy, can be corrected through repositioning strategies without a helmet. The article states that if repositioning strategies continue to improve the shape, a cranial helmet is not required. In severe cases, a helmet is indicated, in which severe cases are less common. Lots of therapist educate parents on repositioning in simple ways, like the changing table, feeding baby, and how to baby sleeps, but they are not most affective sometimes due to the many other places baby spends time on their back. I have made it my mission to raise awareness among parents and therapist that helmets are NOT THE ONLY OPTION. Strict repositioning should be completed before helmets are considered. Email me at [email protected] or submit a FREE head shape form here if you are interested in my services.

Download our free “flat head” guide here to learn more about preventing & correcting “flat head” with your baby.

I hope you leave this article knowing more about plagiocephaly and how to prevent or correct this in your infant!

Have a great day,

Brooke, OTR/L

Owner of Infant Insights, LLC

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