Plagiocephaly in Infants

We have compiled a series of independently written plagiocephaly research papers, consisting of information collected over the past 10 years. The list is continually being added to and gives a broad overview of the current thinking on the subject. We often refer parents who would like to find out more about the condition to this information so they can come to an informed decision before starting treatment with us.

We are often told by the parents who see us that they have been informed there is no evidence that head shape deformities will not self correct. They are also told that helmet type treatments offer no significant improvement over the ‘wait and see’ approach, which the NHS recommends. For more information on what can happen if you don’t treat flat head syndrome, please read our previous article.

However, the contrary view is also true, there is no evidence that head shapes do improve significantly without help. Our experience and that of the parents that we help is that we do gain a rapid and permanent improvement which is radically above what would happen naturally. To hear more about past experience’s of parents whose babies have completed helmet therapy with us, take a look at our parent stories.


To help parents, Steve Mottram, the UK’s leading clinical expert in flat head syndrome correction has compiled expert opinion plagiocephaly research papers, all dedicated to improving the lives of the types of infants that have plagiocephaly and flat head syndrome.

Flat Head Syndrome and Plagiocephaly Research Papers


  • Analysis of the correlation between deformational plagiocephaly and neurodevelopmental delay (2018)
    Aim: This study was designed to investigate whether there is a link between head shape deformity and development delay.
    Findings: The study found that there was no definitive relationship between the severity of deformational plagiocephaly and the degree of developmental delay. The study also indicates that a head shape deformity does not directly affect brain function. You can find the full paper by Mohammed Ahmad Hussein, here.


  • Helmet treatment of infants with deformational brachycephaly (2018)
    Aim: The aim of this study is to discover whether helmet therapy is an effective treatment for brachycephaly.
    Findings: Helmet therapy is an effective and successful method for treating brachycephaly, as well as plagiocephaly. To learn more about the different types of flat head syndrome and their definitive characteristics, please take a look at our quick and easy guide to the different types of flat head syndrome.


  • Effectiveness of conservative therapy and helmet therapy for positional cranial deformation (2015)
    Aim:This study wanted to investigate whether conservative therapy and helmet therapy made a difference in treating plagiocephaly. It involved assessing 4,300 babies and dividing them initially based on head shape severity. Some were given advice only, some were given physiotherapy and the more severe group were given physiotherapy (if indicated) and then helmet treatment.
    Findings: Both conservative therapy and helmet therapy are effective treatments for positional cranial deformation. Treatment may be guided by patient-specific risk factors including poor compliance and advanced age. Read our flat head syndrome treatment page, in order to better understand recommended treatment methods in relation to age.


  • Development in Toddlers with and without Deformational Plagiocephaly (July 2009)
    Aim: This study aims to determine whether the heightened risk of developmental delays seen in infants with deformational plagiocephaly (DP) continues into the toddler years.
    Findings: It found that, on average, children with deformational plagiocephaly scored lower than those unaffected in all areas of the Bayley Scales of Infant and Toddler Development, Third Edition. The findings concluded that a higher level of developmental surveillance may be warranted with these children. Read the full article on how deformational plagiocephaly affects the risk of developmental delays. 


  • Impact of Torticollis Associated With Plagiocephaly on Infants’ Motor Development
    Aim: This study investigates whether congenital or accquired torticollis can affect specific gross motor milestones of infants with plagiocephaly. It involved 175 infants that had plagiocephaly, some were affected and some unaffected by torticollis.
    Findings: The findings suggest that the presence or absence of congenital or acquired torticollis is an important factor that affects gross motor development in infants with plagiocephaly.
    Read the torticollis study to learn more here, or find more information in our related blog post.


  • Review of 5 Articles of “Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Patients with Positional Plagiocephaly” Articles in Neurosurgery 79: E623–E633 (2016)
    Aim: This journal is designed to fill a gap for evidence-based guidelines for medical experts, offering information on how positional plagiocephaly should be diagnosed and treated. It is designed to be used across a range of specialities, including paediatricians, physical therapists and neurosurgeons.
    View the excerpt of this journal here or find online information on Congress of Neurological Surgeons.


  • Brain volume and shape in infants with deformational plagiocephaly (June 2012)
    Aim: Infants with deformational plagiocephaly (DP) have been shown to exhibit developmental delays relative to unaffected infants. Although the mechanisms accounting for these delays are unknown, one hypothesis focuses on underlying differences in brain development. In this study, MRI was used to examine brain volume and shape in infants with and without DP.
    Findings: This study found that infants show differences in brain shape that is consistent with skull deformity. Shape measures were also associated with infant development, however other studies are required to determine whether these developmental delays occur before or after the deformation.
    Read more about plagiocephaly brain volume and shape.


  • Incidence of Otitis Media in Children with Deformational Plagiocephaly (Sept 2009)
    Aim: Deformational plagiocephaly has seen a staggering increase in the last decade, which has been largely attributed to the Back to Sleep Campaign of April 1992. With this increase, the possible clinical associations need to be fully understood.
    Otitis media (referring to certain inflammatory diseases in the middle ear) is one possible association. This study looks at the incidence of otitis media in children with DP, identifying whether it is a significant risk factor.
    Findings: This study showed that plagiocephaly is not a significant risk factor for otitis media, however it did find a trend of direct correlation between plagiocephaly severity and otitis media.
    Read more about this deformational plagiocephaly study.


  • Outcome Analysis of Helmet Therapy for Positional Plagiocephaly Using a Three-Dimensional Surface Scanning Laser (2009)
    Aim: A dramatic rise in positional plagiocephaly has been noted over the last decade. Methods for treating and following outcomes are varied. This study presents its results from a passive soft helmet moulding therapy using a surface scanning laser to provide objective outcomes.
    Findings: This outcome analysis found that head shape improvement was noted after about 4 months, and patients who were more compliant with the therapy achieved better results.
    Read the full outcome analysis of helmet therapy.


  • Risk Factors Associated with Deformational Plagiocephaly (Mar 2008)
    Aim: This plagiocephaly research study was designed to statistically evaluate the independent and interacting effects of biological and environmental risk factors that influence lateralization of deformational plagiocephaly (DP). It was designed to provide future guidance for its clinical treatment.
    Findings: Evaluating more than 2000 children treated for DP, it found that environmental factors such as sleep position could often explain the lateralisation in these children.
    Learn more about deformational plagiocephaly risk factors.


  • Risk Factors for Deformational Plagiocephaly at Birth and at 7 Weeks of Age: A Prospective Cohort Study (Feb 2007)
    Aim: The purpose of this work was to identify risk factors for deformational plagiocephaly within 48 hours of birth and at 7 weeks of age. The study included 380 newborns born at term at Bernhoven Hospital, Sweden.
    Findings: It found that male gender, first-born birth rank and brachycephaly were factors associated with an increased risk of DP at birth. At seven weeks, more factors such as sleeping position and lack of tummy time when awake were also associated with an increased risk.
    Learn more about the risk factors for DP.


  • Effect of Pediatric Physical Therapy on Deformational Plagiocephaly in Children With Positional Preference (Aug 2008)
    Aim: This randomised, controlled trial aimed to study the effect of paediatric physical therapy on positional preference and deformational plagiocephaly. Using a sample of 380 participants, it randomly assigned each infant to receive either physical therapy or usual care.
    Findings: The trial found that a 4 month, standardised paediatric physical therapy programme could significantly reduce the prevalence of severe deformational plagiocephaly compared with usual care.
    Find out more about the effect of paediatric physical therapy here.


  • Deformational Plagiocephaly (Feb 2009)
    Aim: This study aimed to compare head shape measurements, parental concern about head shape and developmental delays in infancy with measurements obtained at follow-up at ages 3 and 4 years.
    Findings: When comparing the results of the 129 children participating in the study, it found that there was a large improvement in both the concern of parents and developmental delays in infancy.
    Find out more about this  follow-up of head shape, parental concern and neurodevelopment at ages 3 and 4 years.


  • Does Helmet Therapy Influence the Ear Shift in Positional Plagiocephaly (Sept 2012)
    Aim: Helmet therapy is widely accepted in the treatment of severe positional plagiocephaly. The improvement of the cranial asymmetry under therapy is evident, but parents are also concerned about the ear shift. This study investigated the influence of helmet therapy on the position of the ears and analysed the reliability of clinical observations regarding cranial asymmetry and ear shift.
    Findings: This plagiocephaly research study found that helmet treatment significantly improves an initial malposition of the external ear in infants with positional plagiocephaly.
    View the study into helmet therapy and ear shift.


  • Prevalence of Positional Plagiocephaly in Teens Born after the “Back to Sleep” Campaign (May 2008)
    Aim: This study aims to provide data on the long-term outcomes of children with plagiocephaly who weren’t treated with remoulding therapy. It looks to determine the prevalence of positional plagiocephaly and brachycephaly in teenagers born after the “Back to Sleep” campaign and before orthotic helmet treatment became widely available.
    Findings: The study found that the prevalence of plagiocephaly and brachycephaly was significantly lower in teenagers (20%) to that found in previous studies with infants (48%).
    Find out more from this study into the prevalence of plagiocephaly.


  • Motor Development of Infants with Positional Plagiocephaly (2010)
    Aim: The purpose of this study was to compare motor development between infants with positional plagiocephaly (PP) and matched peers without PP. It also examined differences in infant positioning practices when asleep and when awake between the two groups.
    Findings: The study showed that infants both with and without positional plagiocephaly spent minimal amount of time in the prone position when awake. More time in this position could help motor development, as well as reduce the deforming compressive forces on their skulls.
    Learn more about the effects of PP on motor development.


  • Quantification of Plagiocephaly And Brachycephaly In Infants Using A Digital Photographic Technique (Sept 2010)
    Aim: The aims of this case-control study were to develop a technique to quantify plagiocephaly that is safe, accurate, objective, easy to use, well tolerated, and inexpensive. It also aimed to compare this method with tracings from a flexicurve ruler. It used a sample of 31 case infants recruited from outpatient plagiocephaly clinics and 29 control infants recruited from other paediatric outpatient clinics.
    Findings: The study showed that the majority of mothers (65%) preferred the photographic method. The study also found that 36.2% of babies were fairly or very unhappy with the flexicurve method, compared to 8.3% that were fairly or very unhappy with the photographic method.
    Much more can be found on the comparison between a digital photographic measurement and a flexicurve ruler techniques here.


  • Helmet Versus Active Repositioning for Plagiocephaly: A Three Dimensional Analysis (Sept 2005)
    Aim: Orthotic helmets and active repositioning are the most common treatments for deformational plagiocephaly. This three-dimensional, whole-head symmetry analysis was designed to compare the outcomes of these treatments, as existing evidence was not sufficient to objectively inform decisions between these options.
    Findings: The results indicated that orthotics helmets provide a statistically superior improvement in head symmetry immediately after treatment.
    Find out more about the results in this study on Helmet Versus Active Repositioning for Plagiocephaly.


  • Prevention and Management of Positional Skull Deformities in Infants (2007)
    Aim: This report provides guidance for the prevention, diagnosis and management of positional skull deformity in an otherwise normal infant, without evidence of associated anomalies, syndromes, or spinal disease.
    Findings: The report states that in most cases, positional skull deformities can be successfully diagnosed and managed by either a paediatrician or your primary health care clinician. Both positional changes and helmets can be used for infant with severe deformities.
    Learn more about the prevention, management and treatment of positional skull deformities.


  • Management of Positional Plagiocephaly (Jan 2007)
    Aim: The purpose of this article is to summarise current concepts in the management of positional plagiocephaly and to highlight the present controversy concerning management of the condition with helmet therapy.
    Find more information regarding positional plagiocephaly management.