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Flattened Head/Positional Plagiocephaly

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Turning little heads keeps them in shape

By George Hoerr, MD

Putting babies to sleep on their backs has greatly reduced the incidence of sudden infant death syndrome – SIDS – in the United States, but it has also led to an increase in a condition called positional plagiocephaly, in which a baby’s head becomes temporarily misshapen from spending so much time in one position. With appropriate treatments, however, the condition will usually correct itself by the time the child is a year old.

Babies’ brains grow rapidly during the first year of life. In order to make room for this growth, they are born with thin, soft skulls. Because infants spend many hours sleeping, constant pressure from a firm mattress can cause the head to flatten, most commonly in the back of the skull. In severe cases, the flattening can affect the child’s vision or cause bulges in other areas of the skull.

A flattened head also can be caused when the neck muscles are too tight, have inadequate tone, or are shorter on one side than the other. This can make the head tilt one way while the chin points in the other direction. Medically, this is called torticollis.

Pediatricians can diagnose positional plagiocephaly or torticollis through an examination of the baby’s head or by ordering X-rays or a CT scan.

The most common treatment calls for positioning the head during sleep so the rounded side of the head is against the mattress. Put your baby to sleep on his back, but make sure to alternate which side of his head rests against the mattress. Changing the position of the crib may help so the baby will look away from the flattened side to see parents or a toy.

Also be sure your baby gets plenty of supervised time on her stomach when she is awake. This takes pressure off the back of the head and builds neck, back, arm and shoulder strength.

If torticollis is causing the flattened head, your doctor or physical therapist may give you simple home exercises to stretch your baby’s neck muscles.

In severe cases of positional plagiocephaly or when the baby’s head has not improved with position changes, the doctor may recommend that the baby wear a special helmet to reshape the skull. In very rare cases, surgery may be necessary.

The benefits of back-sleeping far outweigh the concerns of positional plagiocephaly. With a little extra attention given to alternating the head position and giving the baby tummy time during the day, you can reduce the risk of developing positional plagiocephaly.

Dr. Hoerr practices with CHKD Health System’s Children’s Plastic Surgery

(757) 668-7000

About Dr. Hoerr

Dr. Hoerr is CHKD's staff plastic surgeon specializing in cleft lip and palate repairs, craniofacial reconstruction, craniosynostosis, birthmarks, trauma, ear and hand surgery.

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