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Plagiocephaly (play-gee-oh-kef-a-lee) is a very common craniofacial (skull and face) problem. Deformational plagiocephaly, also known as positional plagiocephaly, means a misshapen, flat or asymmetrical (uneven) head shape. Plagiocephaly does not usually affect the development of a baby's
brain, but if left untreated it may change their physical appearance by causing uneven growth of their face and head.
Plagiocephaly occurs because the bones of a newborn baby's head are thin and flexible, so the head is soft and may change shape easily. Flattening of the head in one area may happen if a baby lies with their head in the same position for a long time. When the head has a flat spot at the back of
the skull, this is called brachycephaly (brak-ee-kef-a-lee).
There is another type of plagiocephaly caused by abnormal closure of the skull bones. This is called synostotic plagiocephaly, and is not addressed in this fact sheet.
It is quite common for a newborn baby to have an unusually shaped head. This can be either related to their position in the uterus during pregnancy, or caused by moulding (changing shape) during labour, including changes caused by instruments used during delivery. Depending on the cause of
the unusual shape, most babies' heads should go back to a normal shape within about six weeks after birth.
Sometimes a baby's head does not return to a normal shape, or they may have developed a flattened spot at the back or side of their head. Sometimes a flat spot develops when a baby has limited neck movement and prefers resting their head in one particular position.
A baby's head position needs to be varied during sleep and when they are awake to avoid them developing deformational plagiocephaly.
If you have concerns about your baby's head shape or if you notice that your baby only turns their head to one side when lying on their back, see your Maternal and Child Health Nurse or GP.
Most babies with deformational plagiocephaly do not need any treatment at all, especially if they are active and you have plenty of one-on-one interaction with them. Plagiocephaly usually improves naturally as your baby grows and gains head control and can move their head by
themselves. The plagiocephaly will get better if you encourage your baby to turn their head themselves when they are awake. From the age of two weeks, while you are supporting their head in your hands, your baby can slowly follow your eyes or voice around, even if one way seems harder at first.
If treatment is necessary, you may be referred to a specialist clinic where your baby will be treated by a team that may include a paediatrician, plastic surgeon, physiotherapist and orthotist.
The most common treatment is provided by the physiotherapist who will encourage active movement, and teach parents how to position their baby and do exercises with them to help improve the head shape.
A very small number of babies with plagiocephaly (less than one in 10) have a severe and persistent deformity, and they may need to be treated with helmet therapy.
A lightweight helmet is made by an orthotist using 3D images and fitted for your baby. The helmet helps to reshape the skull by taking pressure off the flat area and allowing the skull to grow into the space provided.
Helmet therapy is most effective if treatment starts between six and eight months of age and is completed before 12 months, as this is the time of rapid growth of the skull.
Wearing the helmet doesn't hurt and babies usually get used to it very quickly. Parents can sometimes feel quite emotional when their baby first wears the helmet. It can be helpful to know this is a common feeling and to remember treatment is temporary and outcomes are normally very
When your baby first gets their helmet, it will usually be worn for a two-hours-on/two-hours-off cycle for the first two days. This will allow you to monitor your baby's skin and give your baby time to get used to the helmet. Following a review around two days after fitting, your baby will start
wearing the helmet 23 hours a day. The orthotist will then review your baby about every three weeks.
Should I be changing my baby’s head position during the
night while they are asleep?
This is not necessary. Young babies will remain in the position you leave them in. Older children who can move around should be left to sleep, because they will just move themselves back in to their preferred position once you have left the room.
What treatment does a plastic surgeon do for
In the most severe cases, a plastic surgeon will lead a team that remodels a child's head shape with an operation. This kind of surgery is more commonly required for plagiocephaly caused by skull abnormalities (synostosis) and is very rarely required for deformational plagiocephaly.
Developed by The Royal Children's Hospital Plastic and Maxillofacial Surgery, General Medicine, Physiotherapy and Orthotics departments with the University of Melbourne. We acknowledge the input of RCH consumers and carers.
Reviewed June 2020.
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