Plagiocephaly is a term to describe an irregular shape of an infant’s head. It can mean the baby has a flat spot on the back of his head or that it is misshapen.

A baby’s head is quite soft and pliable when first born. This makes a baby’s head very susceptible to external pressures that can change its shape. For example, if a baby spends all his time on his back or in a reclined position with his head resting on a surface like in a car seat or baby bouncer, his head conforms to the shape of the surface and can become flattened. Babies’ heads grow tremendously fast the first year of life, the most of any time in life.

What causes a misshapen head?

• Crowding or positioning in the uterus, especially with multiples and first born babies.
• Spending extended time on the back or with the head resting on a surface while in a car seat, swing or bouncer seat.
• Torticollis, where the baby has a preference toward looking to one side over the other due to tight neck muscles.
• Weakness in neck muscles that make it difficult to control head in upright positions.
• A medical condition called craniosynostosis, in which the bones of the skull fuse together too early. A physician will rule this out.

What is the treatment?

The first recommendation is usually repositioning. Often having a baby change positions by allowing him to play in positions other than on his back can help the skull become round again. On the tummy (tummy time) is the ideal position of play for a baby with plagiocephaly. Babies that are not accustomed to being placed on their tummies can be fussy at first. There are many strategies to help a baby become more used to being placed on his tummy, including offering fun toys, mirrors, or interacting with him while on the floor. Parents are also encouraged to provide other places for baby to play outside of car seats and bouncers. Parents can use a sling, wrap or an infant carrier to carry their babies on the front of their bodies.

It is always recommended that a baby sleep on his back, even if he has a flat spot developing. This is important for the prevention of Sudden Infant Death Syndrome (SIDS).   If a baby has a preference towards turning to one side, parents can alternate which end of the crib they place the baby or where they place the crib in a room. Babies usually will want to look out to the side of the bed that is not against a wall, or where they will see their caregivers come in to pick them up.

Babies should always be in a car seat while traveling in a vehicle, even if they have a flat spot on the back of their head. If the baby has a preference towards turning to one side, fun toys can be placed on the side opposite where he usually looks to encourage strengthening of the other side.

If repositioning has not been effective, a baby’s physician or physical therapist may recommend a cranial orthosis if the plagiocephaly is severe. This is a hard plastic helmet or band that helps flattened areas round out and areas where there is too much growth to slow down.   A baby wears this 23 hours a day and may wear it for several months.

Can I prevent plagiocephaly from occurring?

Plagiocephaly can be prevented. Babies should begin tummy time soon after birth and babies should not spend extended times in baby seats while at home. Babies benefit from being carried in their caregivers’ arms or while in a sling or front pack.   Because babies heads grow so much in the first few months of life, plagiocephaly responds much faster the earlier it is addressed.

Does it matter if my baby has a flat spot?

None of us has a perfectly shaped, rounded head. Most of us have some differences between the sides of our faces. It’s what makes us unique! However, for children with significant differences between the sides of their faces and heads, there may be issues in the future with the fit of baseball caps, glasses, or bike helmets. Significant differences can also potentially affect the way the jaw grows and the joints that hold the jaw to the skull. The good news is that plagiocephaly alone is not linked to learning differences or thinking abilities.

What should I do if I notice a flat spot?

Often a parent will notice the baby’s abnormal head shape before a pediatrician may see it. Other times, it may be noticed during a well baby check up. Parents should alert their health care provider to what they have observed. A physician may recommend that the baby receive physical or occupational therapy especially if there are tight neck muscles or if the baby is slower to develop head control.

Has your child been diagnosed with plagiocephaly? If so, how did you address it?

Maggie Dietrich, MPT, PCS is a Physical Therapist at Penfield Children’s Center. She is a Board Certified Pediatric Clinical Specialist.