Introduction

This guideline relates to plagiocephaly, brachycephaly or misshapen head in paediatric patients. 

Initial workup

For more information please see: Clinical Practice Guidelines: Positional plagiocephaly

• Assessment of Head Shape, include severity assessment scores completed by a physiotherapist (inclusion of the severity score is recommended but 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

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

Routine plagiocephaly can be managed by a local paediatric physiotherapist and does not require tertiary centre referral. Please consider referrals for persistent, marked or atypical cases.

Plagiocephaly, brachycephaly or scaphocephaly

• 0-5 months old (non-urgent 90-180 days)
• 6-8 months old (urgent < 30 days)
• >8 months old will be referred to physiotherapy for enhanced triaging (typically booked urgent < 30 days)
• >10months (Typically non urgent and booked within 180 days)
  Persistent congenital muscular torticollis not improving with treatment. 

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. Children  >10 months corrected age will typically not meet RCH helmet criteria. Please consider this when referring patients to the plagiocephaly clinic.  
• Concerns regarding Craniosynostosis should be referred directly to Cranio-facial service for consult.
• 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. 

Wait time for appointments 

Specialist Clinic wait times 

Services available closer to home

• Albury Wodonga Health
• Bellarine Community Health
• CoHealth
• Eastern Health
• Hastings Community Health
• Monash Children's Hospital 
• Northern Health
• Peninsular Health
• Western Health 

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: Find a physio
• Local private orthotist services are available.

Referral criteria/required information

• Detailed history and assessment
• Growth charts, including head circumference (noting slow growth)
• Concerns regarding head growth or ridging of sutures
• Developmental history

How to refer

Specialist Clinics referral

Please complete the above and submit via:

• Facsimile (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query call ED admitting officer or Registrar on-call (03) 9345 5522

Information for families

• Kids Health Info: Plagiocephaly and brachycephaly
• Baby's head shape info sheet
• Rednose: Tummy time

Resources and links

• Clinical Practice Guidelines: Positional plagiocephaly
• Clinical Practice guideline: Torticollis

Acknowledgements

The development of this guideline was coordinated by the Department of General Medicine, Physiotherapy and Plastics & Maxillofacial. Guideline reviewed in June 2026.