Deformational Plagiocephaly

What is deformational plagiocephaly?

Deformational plagiocephaly is when a baby develops a lasting flat spot on one side the head or the back of the head. It happens when a baby sleeps in the same position most of the time or because of problems with the neck muscles. This condition is also called flat head syndrome.

The condition is different from craniosynostosis. Craniosynostosis is when a baby’s skull bones fuse together before they are supposed to. In deformational plagiocephaly, there is no fusion of the skull bones.

What causes deformational plagiocephaly?

When a baby’s head stays in one position for long periods of time, the skull flattens. Sometimes a baby is born with this flattening because of a tight space in the uterus. This might happen if there is more than one baby. Other things that may lead to deformational plagiocephaly include:

  • Muscular torticollis. Muscular torticollis is a problem that is present at birth (congenital). One or more of the neck muscles is very tight. This tightness keeps the baby’s head in the same position.
  • Prematurity. The skull bones of premature babies are softer. And many premature babies spend a lot of time in the hospital on respirators with their heads in the same position.
  • Back sleeping. Babies who sleep on their backs or in car seats without changing positions for long periods of time can develop flat heads. But the safest way for babies to sleep is on their backs. This reduces the risk for SIDS.

Who is at risk for deformational plagiocephaly?

Babies may be more likely to have this condition if they:

  • Are a first-born child
  • Are male
  • Are born with the help of instruments. These include forceps and vacuum extraction.

What are the symptoms of deformational plagiocephaly?

This problem may not be noticeable or present at birth. It may develop during the first few months of life. A flat spot may appear on one side of the head or the back of the head as the baby grows.

How is deformational plagiocephaly diagnosed?

Your baby’s healthcare provider will check your baby’s head from all positions. He or she will also feel your child's head, particularly along the suture lines. The provider will also measure your baby’s head to figure out how serious the condition is.

How is deformational plagiocephaly treated?

Treatment will depend on your baby’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

  • Changing your baby’s sleep position by turning the head to the opposite side
  • Tummy time when your baby is awake

Some babies do not need treatment. The condition may go away on its own when the baby begins to sit.

If the problem is moderate to severe and turning the baby’s head does not help, your baby’s healthcare provider may recommend a special band or helmet. Helmets usually have an outer hard shell and a foam lining. Gentle pressure helps to re-form the head. As your baby's head grows, the healthcare provider will make changes to the helmet. Some studies have shown that helmets were not helpful for moderate to severe skull problems.

The average treatment with a helmet is usually 3 to 6 months. This will depend on the age of the baby and how serious the condition is. If your baby needs a helmet, he or she will need to be monitored carefully. Helmets must be prescribed by a healthcare provider who has experience with this treatment.

What are the complications of deformational plagiocephaly?

As babies grow and develop, they will move and reposition themselves. This removes the pressure that may have caused the condition. But if the flat spot is moderate to severe, it may not get better on its own. If treatment is not started early enough, your child's head may continue to be uneven.

Can deformational plagiocephaly be prevented?

This condition has increased since the "Back to Sleep" campaign. This campaign was started to decrease deaths from sudden infant death syndrome (SIDS). It has been very successful. It is important that young babies not be placed on their belly to sleep. This is because young babies cannot roll over and move themselves. These tips can help prevent a flat head:

  • Let your baby have tummy time while he or she is awake and you are watching. 
  • Lessen the time your baby spends in car seats and baby carriers. 
  • Hold your baby, giving the baby time to be upright. 

When should I call my child's healthcare provider?

If you notice that your baby’s head is misshapen or you are worried about a flat spot, have your baby checked by his or her healthcare provider.

Key points about deformational plagiocephaly

  • Deformational plagiocephaly is when a baby develops a lasting flat spot on one side or the head or the back of the head.
  • The first step in treating deformational plagiocephaly is changing your baby's head position.
  • Some babies may need to wear a helmet or remodeling band.
  • Mild cases usually go away on their own with simple techniques to change the head position.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

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