What Is Plagiocephaly?

Plagiocephaly is flattening of the side of the back of the skull caused by a baby lying for too long on its back with the head turned slightly to the side. Before birth, plagiocephaly can occur in the womb if the mother’s amniotic sac does not contain enough fluid, or if there are multiple fetuses, such as twins. It also is often associated with premature birth, as premature babies often lack strength in their necks to move the head into different positions when they are lying down. When the head is left in one position too long, the soft skull deforms and flattens where it is in contact with the mattress or whatever surface on which the baby is lying.

Plagiocephaly is more common in male babies than female babies, and more commonly occurs on the right side of the back of the skull. Babies who have torticollis, painful muscle tightness in the neck that forces the head to stay rotated to one side, are particularly susceptible to developing plagiocephaly.

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Signs and Symptoms

The signs of plagiocephaly, brachycephaly, and scaphocephaly are the visible flattening of the skull on the side of the back of the head, the back of the head, or the side of the head, respectively.

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How Is It Diagnosed?

Parents may be the first to notice that the baby's skull is becoming flattened on the back or on 1 side. They may also notice that the baby keeps the head tilted to 1 side because of muscle tightness.

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CAUTION: If you see these problems, seek medical help immediately!

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Your physician will evaluate your baby's head to determine the cause and extent of skull flattening. Your physician may refer your baby to a physical therapist for treatment.

Your physical therapist will conduct a thorough evaluation that includes taking the baby's health history. The physical therapist also will ask you detailed questions about how the baby is handled and the baby's activity level each day, and gently test for signs and symptoms of common plagiocephaly, brachycephaly, and scaphocephaly problems, such as:

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• Flattened skull. The back or the side of the head is abnormally flat.

• Torticollis. The baby has difficulty turning the head to 1 side, or keeping the neck and head straight due to muscle tightness on 1 side of the neck.

• Facial asymmetry. The sides of the baby's face may appear unequal as a result of the skull deformity and flatness.

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Your physical therapist will examine:

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• The shape of the skull and face.

• The baby’s muscle development.

• The baby’s neck, trunk, arm, and leg movement.

• How your baby holds the head and neck.

• How your baby moves the head, body, and limbs.

• How well your baby can lift the head and limbs when lying on the tummy.

• How well your baby can roll over, crawl, and change body positions.

• How well your baby can track objects with the eyes.

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Your physical therapist will likely also test for problems that can possibly occur in babies with severe plagiocephaly, brachycephaly, and scaphocephaly, such as:

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• Delayed muscle development. The baby may not be able to roll, sit up, crawl, or lift the head or reach out with the arms when on the tummy in a way expected for the baby’s age.

• Sensory problems. The baby may show a delay in the development of vision or hearing skills. The baby may have depth-perception problems, and problems tracking moving objects with the eyes.

• Delayed cognitive development. The baby may have delayed development of certain thinking and language skills.

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Your physical therapist will likely collaborate with a physician or other health care provider to make a final diagnosis. Further tests may be necessary to confirm the diagnosis, and to rule out other problems.

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If your physician notices signs of plagiocephaly, brachycephaly, or scaphocephaly before you do, the physician may refer your baby to a pediatric physical therapist for evaluation and treatment.

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How Can a Physical Therapist Help?

Based on the findings during the examination, your physical therapist will develop and implement a treatment plan to address your baby's specific needs.

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Physical therapy for any skull deformations should be started early, often prior to the baby being 3 months old. A physical therapist can help a child who is older regain strength and well-being. Your physical therapist will help improve your baby's:

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Skull shape. Your physical therapist will help your baby achieve and stay in certain positions that will give the skull a chance to become more normally rounded. Physical therapists teach parents this “repositioning therapy,” so it can be done at home. Repositioning therapy is the first line of home treatment. Your physical therapist will teach you how to reposition your baby in ways to aid in developing more normal movements, strength, and skull shape. This therapy usually consists of increased floor time and “tummy time,” and increased times of sitting upright.

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Parents are encouraged to hold their baby more, and to perform other activities to encourage movement. Recent guidelines recommend tummy time 3 times a day, with constant adult supervision. Your physical therapist will design a safe program to gently treat your baby's particular symptoms.

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Based on each child's condition, the baby's pediatrician may prescribe an orthotic device, such as a remolding helmet, to gently redirect the growth of the baby’s skull.

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CAUTION: Babies should not sleep in carriers or strollers at night unless instructed by a pediatrician.

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Motion. Your physical therapist can help loosen any tight neck muscles your baby may have by using specific stretching motions, positions, and hands-on techniques called "manual therapy." These techniques gently help the tight muscles relax, which allows the baby to regain more movement in the neck.

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Strength. Your physical therapist can work on specific skills your baby needs to develop. The therapist may use toys, games, and songs to encourage your baby to learn new movements and strengthen underdeveloped muscles. The program will progress to match the growing skills and strength of your baby.

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Your physical therapist can help improve your own:

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Knowledge. Your physical therapist can educate you about the causes of the flattened skull, and teach you healthier ways to position, feed, and provide safe nap and play times for your baby.

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Preventive skills. You'll learn how to safely place your baby on the tummy (eg, on the floor or in a playpen) after every feeding, nap, diaper change, and whenever the baby is awake and alert. Holding the baby for feedings, rather than feeding the baby in a carrier or stroller, allows the baby to look around, which improves neck and eye movement. A playpen is a good way to allow the baby to be active and safe while giving the parent some time to get chores done, without confining the baby to a container. Changing the position of toys and mobiles in the crib encourages babies to turn their heads in different directions.