The number of positional plagiocephaly cases increased sixfold from 1992 to 1994, occurring in approximately 33 out of every 10,000 births. The reason for this dramatic increase is that in 1992 the American Academy of Pediatrics (AAP) began its "Back to Sleep" campaign, which continues to recommend that babies sleep on their backs to reduce the risk of Premature babies are more prone to positional plagiocephaly because their skulls are softer than those of full-term babies, and they spend a great deal of time on their backs without being moved or picked up. This is because of their medical needs and extreme fragility after birth, which usually requires a stay in the multiple birth infants.
But the differences in head shape seen in children with positional plagiocephaly shouldn't be confused with those caused by craniosynostosis, a more serious condition that occurs when skull bones fuse together too soon, causing an abnormal skull shape and possible brain damage. A child with craniosynostosis may have deformities in the front of the head and a bony ridge over the abnormally fused skull bones. Craniosynostosis is usually corrected with surgery.
What Are the Signs and Symptoms?
Positional plagiocephaly is usually easy for parents to notice. Typically, the back of the child's head (called the occiput) and the ear on the flattened side may be pushed forward. In severe cases, there may be bulging on the side opposite from the flattening and the child's forehead may be asymmetrical (or uneven), although this is unusual in full-term infants. If torticollis is the cause of the baby's flattened head, the neck, jaw, and face may be asymmetrical.
How Is It Diagnosed?
Most often, your child's doctor can make the diagnosis of positional plagiocephaly simply by examining your child's head, without having to order lab tests or X-rays. The doctor will also note whether regular repositioning of your child's head during sleep successfully reshapes the child's growing skull over time (whereas craniosynostosis, on the other hand, typically worsens over time).
If there's still some doubt, X-rays or a CT scan of the head will show your child's doctor if the skull bones are normally separated or if they fused together too soon. If the bones aren't fused, the doctor will probably rule out craniosynostosis and confirm that the child has positional plagiocephaly.
How Is It Treated?
Treatment for the flattened head, if caused by sleeping position, is usually simple and painless for your child. The most common treatment for positional plagiocephaly is repositioning the child during sleep to encourage him or her to alternate the position of the head while sleeping on the back.
Even though your child will probably move his or her head around throughout the night, alternating sides is still beneficial. There are wedge pillows made to keep babies lying on one side or the other, but be sure to check with your child's doctor before using one to ensure that it's appropriate and safe for your baby. The AAP does not recommend routinely using any devices that may restrict the movement of an infant's head.
In addition, you may want to consider moving your baby's crib to a different area of the room. If there's something in the room (a window or toy, for example) that's catching your baby's attention and causing him or her to hold the head in a similar position day after day, moving the crib will coax your child to look at it from another position.
Always be sure your baby gets plenty of supervised time on the stomach when he or she is awake during the day. Not only does "tummy time" promote normal shaping of the back of your baby's head, it also helps in other ways. Looking around from a new perspective encourages your baby's learning and discovery of the world. Plus, being on the stomach will help your baby learn to push up on his or her arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen the neck muscles.
If torticollis is the cause of your baby's flattened head, a course of sleep on his or her back to help prevent SIDS, despite the possibility of developing an area of flattening on the back of the head. However, by helping your baby alternate his or her head position while on the back every night and giving your child plenty of tummy time and stimulation during the day while he or she is awake, you can reduce your baby's risk of developing positional plagiocephaly.
Reviewed by: May 2004