plagiocephaly (Flat Head Syndrome)


“Plagiocephaly” is a word that literally means “flat head”.  It is a condition in which the skull becomes flattened on the back or side when a baby lays too often in the same position.  When babies are very young, their skull bones are quite soft so that if they prefer to lay with the head turned to one side, the skull can flatten on that side.  This is called “deformational plagiocephaly” or “flat head syndrome”.

Plagiocephaly is very common, in fact, estimates suggest that as many as 15% of normal babies can have abnormal flattening of the back of the head.  Plagiocephaly is also more common now than in the past.  In 1992, the American Academy of Pediatrics recommended that babies be placed on their backs to sleep in an effort to reduce the risk of Sudden Infant Death Syndrome (SIDS).  Since that time, the number of SIDS deaths had decreased by more than 50%.  However, at the same time, babies with flattened spots on their head has increased by nearly 600%.

Normally, we would expect that if a baby moved her head equally from side to side, she would not develop flat spots.  But many babies don’t turn their heads equally.  Often, this is because they have a relative imbalance in the tightness of the muscles of the neck, creating a neck position “preference”.  This is called torticollis.  For information about treatment of torticollis, click HERE

Mild plagiocephaly is not dangerous for babies, and may resolve without specific intervention.  More severe cases, however, can impact facial symmetry and can lead to problems with TMJ function, speech, eating, and vision.  Your craniofacial surgeon can help you diagnose plagiocephaly and determine most appropriate treatments.

It is important to distinguish between abnormal head shape caused by positioning (or deformation) and abnormal head shape caused by abnormal growth. The premature closure of cranial growth centers, or “sutures” is called craniosynostosis. This rare condition can cause abnormal head shape because the skull cannot grow normally.  This can also lead to inadequate skull size for normal brain development.  Your craniofacial surgeon can help make this relatively rare diagnosis.  A CT scan or other xray study of the head may be necessary.  Unlike deformational plagiocephaly, craniosynostosis is usually treated with surgery.

Diagonal Discrepancy (DD) is a common measurement used to determine the severity of plagiocephaly.  This is done by using a very accurate digital caliper and measuring diagonally across the head to get the maximum and minimum diagonal measurements.  The greater the difference is between these numbers, the greater the flatness of the skull.  In my practice, DD greater than 10mm is considered severe and worth treating with a helmet.  DD less than 5mm is considered mild and usually not treated with a helmet.


The best treatment for plagiocephaly is prevention.  Frequent repositioning of the baby’s head is a great way to prevent plagiocephaly.  There are several devices on the market intended to help with positioning of the baby in an effort to prevent plagiocephaly.  To my knowledge, there is only one device approved by the FDA for prevention of plagiocephly.  This is the Infant HeadBedTM.  For information about the Infant HeadBedTM, click HERE

Helmet therapy is also a very effective treatment for moderate to severe plagiocephaly.  For information on helmet therapy, click HERE.  Helmet therapy should ideally be started by about 4 months of age, while the skull bones are still fairly soft and easy to mold.  By about 12 months of age, the bones are almost too hard to correct with helmet therapy.  If started early, helmet therapy can usually be completed in about 3-4 months.

Finally, physical therapy can be very helpful in correcting torticollis.  Treatment of this underlying cause of plagiocephaly can help to make the condition better, or at least prevent it from getting worse.  There are good exercises you can do with your baby at home to help with this.

What is plagiocephaly?

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