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Plagiocephalus: Causes, Symptoms and Treatment

Plagiocephalus refers to an asymmetrical flattening of the skull in infants. The condition is typically caused by prolonged pressure on one side of the head during lying positions.

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Things worth knowing about "Plagiocephalus"

Plagiocephalus refers to an asymmetrical flattening of the skull in infants. The condition is typically caused by prolonged pressure on one side of the head during lying positions.

What is Plagiocephalus?

Plagiocephalus (also known as plagiocephaly or flat head syndrome) is an asymmetrical deformation of the skull in which one side of the back or front of the head appears flattened. The term derives from the Greek words plagios (oblique, slanted) and kephale (head). This condition occurs most commonly in newborns and infants, as the skull is still very soft and malleable during the first months of life.

Causes

There are two main types of plagiocephalus:

Positional (Deformational) Plagiocephalus

This is the most common form. It develops due to prolonged one-sided pressure on the soft skull of an infant, which can result from:

Preferred head turning to one side during sleep
Muscular imbalance or tightness of the neck (torticollis), limiting free head rotation
Extended periods lying on the back without sufficient tummy time
Premature birth, as preterm infants often remain in fixed positions for longer periods

Synostotic Plagiocephalus

This rarer form is caused by the premature fusion of one or more of the skull sutures (craniosynostosis). This restricts skull growth in certain directions, resulting in a characteristic cranial deformity. This form generally requires neurosurgical intervention.

Symptoms and Appearance

Typical features of plagiocephalus include:

One-sided flattening of the back or front of the head
Asymmetrical ear position (one ear appearing further forward than the other)
Uneven or asymmetrical facial features
Preferred head position consistently turned to one side
Possibly restricted neck mobility (when accompanied by torticollis)

Positional plagiocephalus does not typically cause pain and, in most cases, does not directly impair brain development. However, early treatment is recommended to minimize cosmetic and functional consequences.

Diagnosis

Diagnosis is usually made through a physical examination by a pediatrician or specialist. The following methods may be used:

Visual assessment of skull shape from above, front, and the side
Measurement of skull asymmetry using a measuring tape or specialized instruments (craniophotogrammetry)
Imaging studies such as ultrasound or CT (computed tomography) to rule out craniosynostosis
Assessment of neck mobility to identify accompanying torticollis

Treatment

Treatment depends on the underlying cause and the severity of the skull deformity.

Repositioning Therapy and Physiotherapy

For mild to moderate cases, conservative management is recommended first:

Regular repositioning: deliberately alternating the infant's head position
Supervised tummy time to relieve pressure on the back of the head
Physiotherapy to address accompanying torticollis
Adjustments to the sleep environment and carrying positions

Helmet Therapy (Cranial Orthosis)

For more pronounced deformities that do not respond sufficiently to repositioning, an individually fitted corrective helmet (cranial orthosis) may be used. The helmet guides skull growth in the desired direction. This therapy is most effective between 4 and 12 months of age, when the skull is still highly malleable.

Surgical Treatment

The synostotic form (craniosynostosis) often requires neurosurgical intervention to open the prematurely fused suture and allow adequate space for brain and skull growth.

Prevention

Several measures can reduce the risk of positional plagiocephalus:

Regularly alternating the infant's head position during sleep
Daily supervised tummy time starting from the first weeks of life
Minimizing time spent in car seats, bouncers, or swings
Encouraging close physical contact through babywearing

References

Mawji A et al. - The incidence of positional plagiocephaly: a cohort study. Pediatrics. 2013;132(2):298-304.
Flannery AM et al. - Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Management of Patients with Positional Plagiocephaly. Neurosurgery. 2016;79(5):E625-E629.
World Health Organization (WHO): Care of the Preterm and Low-Birth-Weight Newborn. WHO Guidelines, Geneva, 2022.

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