Primary Care Liaison

Deformational plagiocephaly

  • The following pre-referral guidelines aim to support local doctors to make appropriate referrals to the deformational plagiocephaly clinic and to ensure all necessary information is provided at the time of referral so the referral can be appropriately triaged.  

    Referral information

    • A medical referral is requested for General Medical/Deformational Plagiocephaly Clinic.  
    • Additional information from the local Physiotherapist and MCHN can be very helpful and we encourage them to liaise with the referring doctor/specialist to include this information with the referral.   

    Initial work-up

    • Assessment of Head Shape, include severity assessment scores completed by a physiotherapist (inclusion of the severity score is recommended by not required)
    • Assessment of neck range of movement
    • Birth history (gestation, mode of delivery including instrumentation, postnatal complications)
    • Thorough general medical and developmental history

    Pre-referral management of plagiocephaly

    • Referral to local paediatric physiotherapist – either through local community health centre, local hospital or privately.  Community physiotherapy, in particular for the management of torticollis, is strongly recommended prior to a referral to deformational plagiocephaly clinic.   
    • No imaging is required. 
    • Please provide relevant handouts to parents/carers regarding Tummy Time, Safe Sleeping, Repositioning of Baby’s Head (see resources below). 

    When to refer

    • Persistent congenital muscular torticollis not improving with treatment. 
    • Please refer infants with persistent plagiocephaly/brachycephaly/scaphocephaly at 4 months of age. 
    • Referral is appropriate for children with the below severity rating scale scores (where available):
      • Plagiocephaly severity assessment score of greater than or equal to 6/15
      • Brachycephaly severity assessment score of greater than or equal to 4/9
      • Scaphocephaly severity assessment score of greater than or equal to 4/9
      • Posterior flattening equal to 2 or more with facial asymmetry
      • Moderate plagiocephaly with developmental delay and/or congenital muscular torticollis

    Please note the following

    • Your child will be seen by a Physiotherapist and/or General Paediatrician depending on needs determined by assessment at triage and in clinic. The clinic does not provide ongoing physiotherapy management. 
    • Children must be reviewed in the Deformational Plagiocephaly Clinic prior to being considered eligible for helmet therapy.
    • The optimal age for helmet therapy is between 6-9 months corrected age. Please consider this when referring patients to the plagiocephaly clinic.  
    • Concerns regarding Craniosynostosis should be referred directly to Cranio-facial surgery  
    • Persistent congenital muscular torticollis not improving with treatment and older than 18 months of age should be referred to General Surgery for an opinion regarding surgical release. 

    How to refer

    • Complete the SPECIALIST CLINIC REFERRAL FORM RCH-Specialist-Clinics-Referral(1).pdf 
    • This allows us to determine the level of urgency for the referral and ensure the patient is triaged to the correct clinic and clinician. 
    • The referral should be faxed as follows:  
      Attention: RCH Deformational Plagiocephaly Clinic 

    Facsimile (03) 9345 5034 
    Telephone (03) 9345 6180*

    *The GP or medical referring doctor should call to check the referral has been received. It can take up to 3-5 days for a referral to be uploaded onto the RCH system 

    Private options

    The RCH General Medical and Deformational Plagiocephaly Clinics are public clinics.  

    There are the following private options:  

    • Local private paediatricians who can assess for presence of torticollis, severity of head shape deformity and causes of both. 
    • Local private paediatric physiotherapists.  Please be aware that these services are very limited in regional and rural areas.  Physiotherapy department can be contacted for further guidance as required however suggest checking the following website which allows you to search for local physiotherapists by area: 
    • Local private orthotist services are available.  

    Contact information

    Specialist Clinics  

    Ph: (03) 9345 6180, 830am -5pm Monday to Friday 

    Fax: (03) 9345 5034 

    General Medicine Department 

    Ph: (03) 9345 5579 

    Physiotherapy Department 

    Ph:  (03) 9345 9300 (via Allied health reception), 830am -5pm Monday to Friday 

    Orthotics and Prosthetics Department 

    Ph:  (03) 9345 9300 (via Allied health reception), 830am -5pm Monday to Friday

    Resources, references and further information

    Related pre-referral guidelines

    • Torticollis