Causes | Types | Symptoms | Diagnosis | Treatment | Complications
What is Plagiocephaly
Plagiocephaly is a form of ‘flat head syndrome’ where a baby has an asymmetrical head shape, usually presenting as one side of the head being flatter than the other.
But, what does plagiocephaly mean?
Plagiocephaly Definition: the plagiocephaly meaning derives from the Greek words ‘plagio’ (slanting/oblique) and ‘cephaly’ (head). It is pronounced as ‘play-gee-oh-kef-allee’
The skull is made up of several plates of bone, which are separate in infancy and connected by flexible ligaments known as sutures. The sutures are there to allow for a normal birth, and to allow the skull to develop as the infant’s brain grows. They retain some flexibility throughout childhood and, as the infant gets older, the bones harden and knit together, creating a permanent skull size and shape that cannot change.
Often, a baby may display birth moulding (in severe cases, known as ‘caput’ head shape asymmetry) immediately after birth, due to pressure from the uterus and birth canal. This usually corrects itself in the first few days of life. After the baby is born, this same flexibility may result in a more lasting re-mould of the baby’s skull if they continually lie in the same position for a prolonged period of time.
If you have any questions about when your baby’s soft spot should close, please read our informative blog post that covers what a soft spot actually is, when it should close and how a baby’s soft spot affects the overall head shape.
Plagiocephaly is a condition characterised by an asymmetrical head shape deformity, which occurs in early infancy and can continue throughout life. The plagiocephaly definition is summarised by the word plagiocephaly translating as ‘oblique head’. This form of flat head syndrome is a deformation of the head which is typically marked by an oblique slant to the skull surface.
There are many more specific terms to define head shape deformity types, including Positional Plagiocephaly (PP) and Deformational Plagiocephaly (DP). However, these both mean the same thing.
There are a number of different causes of plagiocephaly, which we will explore below.
What Causes Plagiocephaly?
There are a number of known causes of plagiocephaly with some more common than others. As mentioned above, when external pressure is repeatedly applied to one area of the baby’s skull, flattening may appear. A common cause of plagiocephaly is pressure to the back of the head.
Back to Sleep Campaign
The Back to Sleep campaign of the early 1990s encouraged parents to put their babies to sleep on their backs to reduce the incidence of Sudden Infant Death Syndrome (SIDS). The campaign was successful, resulting in an 80% decrease in SIDS. However, if a baby spends too much time on their back, the pressure applied to the back of their head can lead to plagiocephaly. We strongly advocate for putting your baby to sleep on their back and giving your baby opportunities for supervised tummy time when they are awake. This not only strengthens your baby’s core muscle group but also takes some of the pressure off the back of their head. For more information on creating a safe sleep environment for your baby, please read our previous blog post. You might also wish to explore our tummy time guide which has been written for parents. The guide covers the best time to start tummy time, the different exercises and how to do them in the safest way.
In Utero and Birth Factors
Plagiocephaly can also be caused by earlier factors in the baby’s life. Sometimes a baby can experience pressure in-utero – sometimes from sharing a crowded womb with a twin or triplets. This can lead to flattening of the head while it is still soft. Babies who are born prematurely have even softer heads than full-term infants and, consequently, can be susceptible to plagiocephaly. Additionally, some methods of assisted birth, such as forceps or vacuum delivery, can affect the shape of the baby’s head, creating a cone-like shape.
Another cause of plagiocephaly is a congenital condition that results in a premature fusion of the baby’s sutures. This is known as congenital plagiocephaly and is treated differently to acquired plagiocephaly, such as positional or deformational plagiocephaly. Please continue reading to learn more about the types of plagiocephaly.
Types of Plagiocephaly
There are several types of flat head syndrome, such as brachycephaly, scaphocephaly, and plagiocephaly. Plagiocephaly is the most common, and there are a number of types of plagiocephaly in itself.
Deformational and Positional Plagiocephaly
You may have come across positional plagiocephaly and deformational plagiocephaly. These specific terms actually refer to the same kind of plagiocephaly that is acquired by positioning or from external pressure to the malleable skull, in utero or after birth, leading to a flat spot. This isn’t the same as craniosynostosis where the flat spot is caused by bone fusion.
There are also terms such as ‘posterior plagiocephaly’ and ‘anterior plagiocephaly’. These terms refer to the location of the area affected by the deformational or positional plagiocephaly. Posterior plagiocephaly refers to flattening at the back of the head, and anterior plagiocephaly refers to flattening at the front. Posterior plagiocephaly is more common due to the positioning of babies on their backs while anterior plagiocephaly might be caused by babies who turn their heads to one preferred side.
Congenital or Synostotic Plagiocephaly
Congenital or synostotic plagiocephaly differs from deformational plagiocephaly as it refers to plagiocephaly caused by the fusion of the coronal suture. Please read more about this on our craniosynostosis page as the stages of diagnosis and treatment differ from those for acquired plagiocephaly.
The type of plagiocephaly dictates the best course of treatment, which is ascertained by a clinical diagnosis. If you think your baby might have plagiocephaly, please review the symptoms below.
Although it may seem daunting at first, when plagiocephaly is spotted and addressed early, the symptoms can be significantly improved. This is because the earlier the flattening is treated, the longer the skull has to mould into the correct head shape before the sutures fuse at around 14 months of age.
You might notice a plagiocephaly head shape as early as at birth, but some babies don’t present until about eight weeks age with the following main signs and symptoms:
- An asymmetrical head shape
- A flattening of one part of the skull, usually at the side or towards the back of the head
- Further flattening at the front of the head or face, which can occur as a secondary issue
- Possible migration of the back part of the skull, with flattening across the midline
- Ear misalignment, where the ear of the flattened side is pushed forward
- Prominent cheek and brow on one side
- Compression and shortening of one side of the cheek in comparison to the other
These symptoms are dependent on the type and severity of the plagiocephaly. Our information on classifying plagiocephaly will provide you with a primary indication of how severe the deformity is. Additionally, our informative guide on the signs and symptoms of plagiocephaly can be of further help.
How to Diagnose Plagiocephaly
If you have noticed any of the signs and symptoms of plagiocephaly in your baby and are concerned, we recommend seeing a clinician as early as possible. We offer free no-obligation pre-assessments at your local Technology in Motion plagiocephaly clinic where a specialist can ascertain the instance and severity of a plagiocephaly diagnosis.
At a consultation, the clinician will examine and assess your baby’s head to determine the classification, before exploring treatment options with you.
Plagiocephaly is typically classified into the following categories of severity:
- Mild Plagiocephaly – Most babies with mild plagiocephaly experience an improvement of flattening as a result of repositioning techniques and regular tummy time.
- Moderate to Severe Plagiocephaly – Moderate to severe plagiocephaly often requires a different route of treatment such as a cranial moulding helmet. If this is the case, your clinician will discuss this with you in-depth.
Find your nearest clinic on our plagiocephaly clinics page.
Plagiocephaly treatment for babies varies depending on the severity of each case. As mentioned, for many mild cases, we recommend repositioning techniques for plagiocephaly, while more severe cases may require further treatment.
For mild cases, plagiocephaly treatment without a helmet includes repositioning techniques. Keeping your baby off their back during waking hours can have a huge benefit to their head shape and also gives them the opportunity to practice tummy time which is advantageous to their core strength and motor skills.
At naptime, we would recommend allowing your baby to sleep in a sling throughout the day, rather than a baby carrier or Moses basket, when possible. This keeps the pressure off the back of your baby’s head during the day and has added bonding benefits from the closeness to your baby. For the best ways to carry your baby and repositioning techniques for plagiocephaly, please read our repositioning guide.
In more severe cases, plagiocephaly repositioning may not be enough to correct the head shape. In these cases, we might recommend the plagiocephaly helmet therapy route. A baby helmet for plagiocephaly is a lightweight helmet worn over several months to guide the head into the correct shape. We now offer two models of plagiocephaly helmet – the TiMbandAir and the TiMband. Please visit our plagiocephaly helmets and 3D printed helmets pages for more information on helmet therapy. Additionally, our plagiocephaly treatment page outlines the treatment options in further detail.
If your baby has moderate to severe plagiocephaly, we would recommend treatment in light of the possible consequences of untreated plagiocephaly.
Research has found links between untreated deformational plagiocephaly and developmental delays in toddlers, based on the Bayley Scales of Infant and Toddler Development. While this isn’t a causal relationship, it’s something to be aware of before making your decision about treatment.
There can also be a number of practical complications of untreated plagiocephaly, such as finding helmets and headgear to fit individuals with deformational plagiocephaly. This struggle could even extend to finding glasses that fit well if the untreated plagiocephaly affects the alignment of the ears.
Thirdly, there can be a psychological impact of untreated plagiocephaly due to the shape of the head as a result of the flattening. These are all factors to consider if your baby has received a plagiocephaly diagnosis, and we go into further detail in our informative guide about the possible long term effects of plagiocephaly.
You can book a free pre-assessment with a plagiocephaly specialist at any one of our plagiocephaly clinics in the UK. At your consultation, one of our specialists will assess your baby’s head shape and won’t recommend treatment unless it’s necessary.
Plagiocephaly research is vital for both clinician and parent in understanding the full extent of the condition and its effect on the baby. To help parents, we have compiled a selection of research papers that are all dedicated to improving the lives of babies with the condition. If you would like to read about our success stories, our plagiocephaly case studies are devoted to the individual journeys of both parents and children who have benefited from the treatment we offer. We also have a collection of plagiocephaly before and after treatment pictures, to give you an idea of what results can be achieved with helmet therapy. Alternatively, join our social community and read about parents’ first-hand experiences on our Facebook page. These can also be found on our parent stories page.
If you have any questions, we would love to hear from you. Please call us on 0330 100 1800.