Plagiocephaly 

literally meaning ‘oblique head’. Deformational plagiocephaly, also known as ‘positional plagiocephaly’, refers to a misshapen (asymmetrical) head shape.

• results from repeated external pressure to an infant’s skull due to the head being in one position for extended periods
  • Back sleeping
    • Infants who sleep on their backs and/or in car seats without alternating their position are at increased risk of deformational plagiocephaly.
  • Muscular torticollis
    • This is a congenital condition caused by shortening or tightening of one or more of the neck muscles.
    • This causes the infant’s head to tilt and/or turn to favour one particular direction.
  • Prematurity
    • The cranial bones of premature infants are very soft and malleable following birth, and therefore more susceptible to external pressures.
  • In utero constraint
    • Less frequently, a baby is born with a flattened skull due to a restricted intrauterine environment or ‘crowding’ (i.e. multiple births, breech position, small maternal pelvis)

• Treatment options
  • Treatment will vary depending on the nature and severity of the deformity. 
  • Many mild cases do not require any treatment and the condition will improve spontaneously when the infant begins to sit. 
  • Early diagnosis of co-existing torticollis is important as this does require treatment by a paediatric physiotherapist.
  • More severe deformity may warrant treatment. 
  • In these cases early referral is advised (between 4-8 months of age) as the majority of cranial growth is achieved during the first 12 months of life, and the greatest amount of correction will be achieved during this time.
• Counter positioning
  • Counter positioning is recommended where a helmet is not warranted and is most effective between birth and 4 months of age. 
  • This involves consistently repositioning the infant’s head so that they do not rest on the flat spot. 
  • Increased tummy time and side lying play when the infant is awake is also encouraged. 
  • Positioning with rolled up towels can sometimes be of assistance. 
  • Counter positioning techniques can be taught by health professionals, including maternal and child health nurses and paediatric physiotherapists.
• Helmet therapy
  • In moderate to severe cases of deformational plagiocephaly, and/or where a trial of counter positioning has failed, a cranial remodelling helmet may be recommended. 
  • The helmet assists the skull moulding process by removing the pressure over the flat area, allowing the skull to grow into the space provided. 
  • Helmets are most effective between 4-8 months of age. 
  • The helmet is made of an outer hard shell and is lightweight with a foam lining. 
  • They are Custom-made to fit the infant’s head by an experienced orthotist. 
  • The average duration of helmet therapy is usually 2-6 months, depending on the age of the infant and the severity of the deformational plagiocephaly.
  • The helmet is required to be worn for 23 out of 24 hours every day. 

Craniosynostosis  

• also present with asymmetrical skull shapes. 
• In craniosynostosis, however, the skull deformity results from premature fusion of one or more of the skull sutures. There is no premature sutural fusion in deformational plagiocephaly. 
• The skull and facial asymmetry in craniosynostosis is typically more severe than that of deformational plagiocephaly