Understanding Positional Plagiocephaly: A Guide for New Parents
measuring plagiocephaly can be helpful to track improvement over time
If you're reading this, you might be concerned about the shape of your baby’s head. First of all, take a deep breath—positional plagiocephaly (or “flat head syndrome”) is more common than you might think, and it’s usually not a cause for alarm. With early assessment and gentle treatment, babies often recover fully with no lasting issues. In this blog, we'll explore what positional plagiocephaly is, how healthcare we can help, and what you can do at home to support your little one.
What Is Positional Plagiocephaly?
Positional plagiocephaly occurs when a baby’s head becomes flattened on one side, usually due to spending too much time in one position. Because babies have soft, malleable skulls, lying on their back for extended periods (especially during sleep) can cause a flat spot to develop. If your baby has a preference for turning their head in one direction or sleeping with their head rotated in one direction this can also contribute to the asymmetry. It’s most common in the first few months of life, especially after the “Back to Sleep” campaign successfully encouraged parents to put babies on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS).
The good news? Plagiocephaly is usually a cosmetic issue and doesn’t affect brain development. However, it’s important to address it early to ensure it doesn’t become more pronounced or affect your baby’s movement and motor development. A strong head or neck preference can also mean that tummy time or feeding your baby in certain positions can be difficult.
How Do We Assess Positional Plagiocephaly?
When you bring your baby in for an assessment, a paediatric osteopath or physiotherapist will first do a thorough visual inspection of your baby’s head and neck movements. One tool we often use to measure the extent of the flatness is a craniometer.
A craniometer is a simple device that allows us to measure the symmetry of the head by taking specific measurements across the skull. We use these measurements to calculate something called the plagiocephaly index. This gives us a clearer idea of the severity of the flatness:
Mild: 0-5% asymmetry
Moderate: 5-10% asymmetry
Severe: More than 10% asymmetry
These measurements help us track improvement over time and guide treatment recommendations.
How Can Pediatric Osteopaths and Physiotherapists Help?
1. Gentle Hands-On Techniques
A common approach used by pediatric osteopaths and physiotherapists is gentle hands-on treatment to address muscle tension, particularly in the neck and upper body. Often, babies with plagiocephaly will have a condition known as torticollis, where the muscles on one side of the neck are tighter than the other. This makes it uncomfortable for your baby to turn their head, which leads to spending more time on one side and worsening the flat spot.
During sessions, we use light pressure and stretching techniques to release tight muscles, promote mobility, and improve symmetry in head movements.
2. Home Exercises
To reinforce the treatment your baby receives during therapy, we’ll guide you through some simple home exercises. These exercises are designed to encourage your baby to use their muscles and develop strength, flexibility, and coordination. Your home program might include exercises to promote tummy time, head rotation, overall body strength and gentle stretches. We may also give advice on positioning your baby when settling, feeding and playing with your baby.
The Importance of Early Intervention
While positional plagiocephaly doesn’t affect brain development, it’s still important to address it as early as possible. Babies' skulls are soft and moldable, but as they grow older, the bones begin to harden, making it more challenging to correct flat spots. Treatment is generally most effective when started within the first few months of life.
What the Evidence Says
Research shows that early intervention is key. A 2014 study published in the Journal of Craniofacial Surgery emphasized the importance of addressing plagiocephaly early through repositioning and physical therapy . Another study found that hands-on therapy, combined with home exercises like tummy time, can lead to significant improvements in head shape .
According to the American Academy of Pediatrics, physical therapy is often recommended as a first-line treatment for positional plagiocephaly, particularly when it's associated with torticollis. They also stress the value of tummy time and repositioning strategies to encourage balanced development .
Reassurance for Parents
If you’re feeling overwhelmed, you’re not alone. Many new parents worry about the shape of their baby’s head, but remember, positional plagiocephaly is treatable, especially when caught early. Working with a pediatric osteopath or physiotherapist, along with simple home exercises, can lead to significant improvement in a short amount of time. Most importantly, your baby’s brain development is not affected, and with the right care, they’ll grow up happy and healthy.
If you have concerns about your baby’s head shape, don’t hesitate to reach out to one of our paediatric trained osteopaths. You can book an appointment here
References:
Journal of Craniofacial Surgery, 2014. "The Importance of Early Intervention for Positional Plagiocephaly."
Archives of Disease in Childhood, 2012. "Effectiveness of Physical Therapy for Plagiocephaly in Infants."
American Academy of Pediatrics, 2020. "Clinical Report on the Management of Positional Skull Deformities."