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Pediatric Neurosurgery

Positional Plagiocephaly (Flat Head Syndrome)

Comprehensive Head Shape Clinic for Babies at UH Rainbow Babies & Children’s

What is positional plagiocephaly? Also known as flat head syndrome, positional plagiocephaly is a condition in which an area of an infant's head develops an abnormally flattened shape. The condition usually occurs when an infant always sleeps with its head turned to the same side during the first few months of life.

University Hospitals Rainbow Babies & Children's Hospital offers a multidisciplinary Head Shape Clinic that specializes in the evaluation, diagnosis and treatment of children with head shape abnormalities, including positional plagiocephaly and craniosynostosis.

Your child’s health is important. Make an appointment today.

Schedule an appointment today with the pediatric experts at UH Rainbow. Call 216-844-5741, press option 3.

What Causes Flat Head Syndrome?

A baby’s sleep position is the most common cause of a flattening of the head. Because the safest sleep position for infants is on their backs, and because infants often lie on their backs for a large portion of the day, their heads can flatten in one area. This happens not only during sleep but also when sitting in carriers, infant car seats, strollers, bouncy seats and swings. When a flattening occurs at the back of the head, the condition is referred to as brachycephaly.

Because their skulls are softer than those of full-term babies, premature babies are more likely to develop positional plagiocephaly than full-term newborns. Preemies may spend more time on their backs without being moved or picked up as a result of their medical needs and their time spent in a neonatal intensive care unit (NICU).

Positional plagiocephaly can begin before birth if the presence of a twin or the mother’s own pelvis creates abnormal pressure on the baby’s skull. It’s not uncommon for children from multiple births to be born with flat spots on their heads.

Another cause of flat head syndrome is a neck condition called torticollis. Also known as wryneck or twisted neck, torticollis is a twisting of the neck that causes the head to rotate and tilt at an odd angle. Because babies with this condition have difficulty turning their heads, they tend to keep their heads in the same position when lying down. As such, torticollis sometimes leads to a flattening of the skull. Once a flat spot develops, the torticollis itself can worsen.

What Are the Symptoms & Signs of Flat Head Syndrome?

Parents can usually identify positional plagiocephaly themselves. The main symptoms are:

  • The back of the baby’s head is flatter on one side.
  • On the flatter part of the head, the infant typically has less hair.
  • The ear on the flattened side of the head may appear pushed forward when you look down at the baby’s head.

In severe cases, the child’s forehead may bulge on the side of the flattening and may appear uneven. If torticollis is the cause of the positional plagiocephaly, the face, neck and jaw might be uneven, too.

How Is Positional Plagiocephaly Diagnosed?

Doctors can generally diagnose positional plagiocephaly by a simple examination. The doctor may also check for torticollis by observing how a baby moves its head and neck. Further medical testing is usually not necessary. In certain cases, we may use the STARScanner laser data acquisition system – special technology that is safe, takes less than 2 seconds and captures detailed head shape measurements, particularly if craniosynostosis or a similar condition is a suspected cause of the skull flatness. Craniosynostosis is a condition in which the flexible, fibrous joints (called sutures) that separate the plates of the baby’s skull close too early, causing problems with normal skull and brain growth. A STARScanner scan provides definitive information on the volumes, symmetry ratios, circumference and linear measurements of the head. If craniosynostosis is the cause of a baby’s positional plagiocephaly, our team may be able to facilitate a same-day appointment with one of the members of our craniofacial team, including a pediatric craniofacial surgeon and/or pediatric neurosurgeon.

Other imaging technologies we may use in the diagnosis and assessment of positional plagiocephaly include ultrasound, x-ray and CT scan imaging.

How Is Positional Plagiocephaly Treated?

UH Rainbow’s multidisciplinary Head Shape Clinic is located at the Zagara Pediatric Specialty Clinic at our main campus in Cleveland, Ohio. The clinic includes a team of clinicians from Pediatric Neurosurgery, Pediatric Plastic Surgery, Pediatric Physical Therapy, a representative from Hanger Clinic (our helmet vendor), and access to the STARScanner for a complete evaluation in one visit for patient/family convenience.

Correction of positional plagiocephaly at the clinic focuses on assessment, repositioning, physical therapy and helmet therapy.

Treatment of positional plagiocephaly at the clinic focuses on a comprehensive evaluation from the following experts and services:

Positional Plagiocephaly Improves With Time & Natural Growth

As they grow older, babies start to change position themselves while sleeping so that their heads aren’t always in the same position. Once a baby can sit on their own, their flat spot usually will not worsen. Over months and years as the skull grows, the flattening will improve, even in severe cases. In addition, the flat spot often becomes less noticeable as hair grows in over the child’s first few years of life.

Positional Plagiocephaly does not affect the growth of child's brain. However, neck stiffness can slow early development. Physical therapy for torticollis will usually include evaluation of the infant's progress and additional exercises to address any delays.


The Head Shape Clinic is open on the first, third and fifth (when applicable) Thursdays of every month, 9 a.m. – noon.


To refer a patient to the Head Shape Clinic, contact Brianna Moss at Brianna.Moss@UHhospitals.org or 216-844-5741, option #3.

The UH Rainbow Head Shape Clinic is staffed by pediatric nurse practitioners Catherine Harrigan and Charles Novince from Pediatric Neurosurgery and Plastic Surgery. If they are concerned that a baby may have a diagnosis beyond positional plagiocephaly, they will arrange for further physician evaluation.