Positional Plagiocephaly -
Positional Plagiocephaly is the most common positional
head deformity and often presents with a parallelogram
head shape when viewed from above. A positional head
deformity is a condition that is caused by repeated
external pressure applied to the same area of the skull.
Due to the way in which the infant’s skull can mould
during birthing, it is possible for repeated external
pressure to cause the bones of the skull and face to
shift, resulting in a head deformity and facial
- The most disturbing fact about Positional Plagiocephaly is that majority of cases are preventable.
- The truth is there are no steps that can be taken to
prevent Positional Plagiocephaly from occurring in Utero.
- It is possible to prevent the majority of cases that
develop after birth.
- Although we have been told time and again to keep
babies on their backs to reduce SIDS, the one thing we
were are not told is to change and vary the baby’s
position so that the baby is not always resting on the
back of the head.
- The number one preventative measure is to vary the
sleeping position of the baby.
- Be aware of how the baby sleeps and take steps to make
sure that equal time is spent on both sides of the head
- Before a child has the ability to roll, sleep positioners such as wedgers can be used to vary the
- Once it becomes difficult to dictate the baby’s sleep
position, toys should be placed on both sides of the cot
to discourage the child from always looking in one
- When holding your baby in your arm, be sure to
alternate arms to ensure that time is spent on both
- If the baby is bottle fed, alternate the arms that you
hold your baby with during feeding to ensure time spent
on both sides
- Implement “Tummy Time” during play.
- Prevent the extended use of car seats (used as a
Being able to recognize the signs of Congenital Muscular
Torticollis (CMT) is also important in prevention of
Positional Plagiocephaly. If the baby tends to always
turn in one direction or the head is always tilted to
one side it is possible that Congenital Muscular
Torticollis could be the cause. Although it is true that
not every baby with CMT will have Positional
Plagiocephaly, there is a high enough incidence rate of
a baby having both disorders those parents should be
able to recognize the warning signs and bring concerns
up with the baby’s pediatrician.
Positional Plagiocephaly - Frequently
Please note that this information is not provided
directly from a doctor and should never be used in the
place of a doctor. The goal in providing such
information is to help other parents, family members and
care givers of Plagio kids to understand what Positional
Plagiocephaly is, what causes it, and finally how to
What is Positional Plagiocephaly?
Many infants are born with abnormal
head shapes, caused by circumstances in the birthing
process; most abnormal heads will correct themselves
within six weeks after birth. Should this not correct
itself, you need to determine the cause. A correct
diagnosis by a doctor or specialist is essential.
The diagnosis normally given is Positional Deformity
of the head.
The most common is Positional Plagiocephaly.
Positional Plagiocephaly is caused when there is
repeated external pressure applied to one side of
the back of the head which then causes a flat spot.
The side of the head that is flattened will often be
accompanied by a prominent forehead, which when
viewed from above will give the head a parallelogram
shape instead of a normal symmetric oval shape.
It is also common for an infant with Positional
Plagiocephaly to have misaligned ears - the ear on the
effected side may be pulled forward and down - and
facial asymmetry, with the affected side of the face
having a fuller cheek, and a more prominent appearance.
Facial asymmetry on the affected side can also include a
jawbone that is tilted, and an eye that appears
displaced and mismatched in size.
Why is it called Positional Plagio?
Positional is used as this therefore differentiates from
true Synostosis, which is the premature fusion of one or
more of skull sutures (Craniosynostosis) and requires
surgery to repair.
When the term Positional is used, it means that
there is NO premature fusion of the sutures, it has
actually been caused by external pressure on the skull
and this has then caused the deformity.
Types of Positional Head
Positional Plagiocephaly is not the only
Positional Head Deformity, though it is by far the most
Positional Brachycephaly is when the whole back
of the head is flat and the head has the appearance of
being wide and short. Positional Brachycephaly is most
often seen when a child sleeps entirely on the back of
Positional Scaphocephaly is when the head is
long and narrow. This is caused when the infant is in a
breech position during the pregnancy and the head
becomes wedged underneath the mother’s ribs.
Prematurity can also be a contributing factor to
Facial Asymmetry - What is this?
push the skull and cause deformity , this in turn can
affect the features of the face.
is when one side of the face does not match up with the
other side of the face.
Most often the
affected side will have a more pronounced forehead and
possibly a cheek that is fuller then the other cheek.
It is also
possible to see the eye on the affected side appear
displaced and mismatched in size and for the jaw to
All or some of
these factors can make the face appear skew.
Are the affects of Positional
Plagiocephaly just cosmetic?
Plagiocephaly has been viewed as a purely cosmetic
disorder as it is believed to not restrict brain growth
or cause brain damage.
can arise, such as, problems with chewing and eating.
There is a possibility of
experiencing problems with vision, this could become
an issue and may require corrective surgery to
Should I suspect my child has
Plagio who would I then consult?
How would the diagnosis be
X-Rays, CT-Scans and MRI’s are normally performed
to confirm the diagnosis.
Testing is normally done to confirm that the head
deformity is not being caused by a true Synostosis.
What causes Positional
Inventro: When a baby
develops in a womb that is restricted, it can lead to
Positional Plagiocephaly. A baby that is in a breech
position can also develop Positional Plagiocephaly if
the baby’s head becomes wedged under the mother’s ribs.
Prematurity: The skull of a
premature infant can be very soft making the head more
susceptible to remolding due to external pressures.
Back Sleeping: Parents are
not given enough information regarding back sleeping and
how an infant’s sleeping position should be alternated
to prevent constant sleeping on the same side, parents
are not informed of the importance of “tummy time” .
What is Congenital Muscular Torticollis (CMT)
Muscular Torticollis (CMT), which is also referred to as
a Twisted Neck, is a condition that is usually caused
when one or more of the neck muscles is shortened or
tightened on one side.
This causes the
baby’s head to tilt and/or to turn in one particular
can be very blatant or very subtle. Parents
are usually the first to notice the more subtle
If your baby
tends to always look in one direction then it is very
possible that CMT could be the cause.
If you suspect
that your child may have CMT it is important to have a
doctor confirm this diagnosis
Treatment of CMT
usually consists of physical therapy to lengthen and
loosen the affected muscle(s).
In severe cases
is surgery needed to repair the muscle(s).
therapy is simply the concept of repositioning the baby
so that he does not rest on the flat spot.
It is believed
that by removing the external pressure, the flat area
will correct itself as the head grows.
reposition therapy it is important that the baby be
cleared of Torticollis.
If the baby has
Torticollis it is important that parents discuss this
with the baby’s physician and utilize physical therapy
to stretch the neck muscles.
therapy is to be used, the baby’s pediatrician should be
consulted on the best way to achieve this.
practices are placing a blanket or pillow against the
flattened side to prevent the baby from rolling over.
can place the babies toys on the opposite side of the
flattening in the cot to make the child look in that
Adding "Tummy Time" can also assist
An infant’s skull is made up of
free-floating bones that are separated by sutures. The
sutures, which act as expansion joints, allow the skull
to mold for birthing and to expand with the rapidly
While many infants are born with
an abnormal head shape, due to the trip through the
narrow birth canal, most will correct themselves within
six weeks following the birth. When an abnormal head
shape persists or is not noticed until after six weeks,
it is important to determine the cause. A correct
diagnosis is essential and should be made by a qualified
The diagnosis most often given is of
a Positional Head Deformity. Due to the malleable nature
of an infant’s skull, it is possible for external
pressures to cause skull deformity. The most common
Positional Head Deformity is Positional Plagiocephaly.
Positional Plagiocephaly is caused when repeated
external pressure is applied to one side of the occiput
(the back of the head) and a flat spot occurs. The side
of the occiput that is flattened will often be
accompanied by a prominent forehead, which when viewed
from above will give the head a parallelogram shape
instead of a normal symmetric oval shape.
also common for an infant with Positional Plagiocephaly
to have misaligned ears (the ear on the effected side
may be pulled forward and down and be larger then the
unaffected ear) and facial asymmetry, with the affected
side of the face having a fuller cheek, and a more
prominent appearance. Facial asymmetry on the affected
side can also include a jawbone that is tilted, and an
eye that appears displaced and mismatched in size.