Plagiocephaly is the medical term for abnormal head shape. Persistent back lying is the most common reason for this abnormal head shape, which is often referred to as deformational plagiocephaly or positional plagiocephaly.

How does this happen? During the first few months of life, infants have poor head control and often prefer to lie with their head turned the same way night after night. If this is continued for many weeks or months, it can lead to increased flattening on the back of the head or side of the head that the child favors. This can be even more exaggerated if there is a condition known as torticollis where the neck muscles are overly tight on one side. Importantly, infants should always be put to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS) even at the risk of developing plagiocephaly.

The recommended age to refer a child to the program is between 3 to 18 months. Severe head concerns should be evaluated by 4 months of age. Mild to moderate head concerns should be seen by 6 months.

Positional plagiocephaly often improves with conservative management – avoiding activities and equipment that put prolonged pressure on your child’s head and encouraging tummy time and side-lying positioning while awake.

As your child grows and gains better head control, the shape of the head will improve. These improvements should be evident once your child begins to sit up and spend significant time on his or her belly.

In rare cases, children with abnormal head shape will be diagnosed with a different condition called craniosynostosis, which is the premature fusion of one or more bones of the skull. This is one of the reasons it is important that your child is evaluated by a medical specialist before pursuing a helmet for plagiocephaly. Craniosynostosis requires surgical treatment with our team of pediatric neurosurgeons and pediatric craniomaxillofacial surgeons at Orlando Health Arnold Palmer Hospital for Children, and should be ruled out as a cause for an infant’s abnormal head shape.

• If your child has positional plagiocephaly, our team will provide education for the best conservative treatments. Remember, you should always place your baby to sleep on his or her back for safety. When your baby is awake, you should minimize the amount of time your baby spends on his or her back. Choose different positions and ways for your baby to be held during the day.
• If your infant has a problem with limited movement of the neck because of tight or shortened muscles (torticollis), we can recommend exercises or provide a referral to a physical therapist. These should help your child to improve movement of the head and decrease pressure on the affected area.

Most children’s head shape improves without the need for a cranial orthotic remodeling device, also known as helmet therapy. As they grow, they become more active and spend less time laying on their backs. Our team may recommend helmet therapy if your child’s head has a significant amount of abnormality or flattening. This form of treatment is determined through a multi-disciplinary evaluation by our craniomaxillofacial and neurosurgical specialists and is based on several factors, including the degree of flattening, your baby’s age and other contributing medical conditions.

If a helmet is recommended, our specialists will refer to you to an orthotist, a specialist trained to design and fit your child’s helmet. The helmet will need to be worn for 23 hours per day for about three months. Regular follow-up visits to the orthotist are also needed for proper care and benefit.