What is Positional Plagiocephaly?

Positional plagiocephaly (play-gee-o-seff-ah-lee) is a medical term meaning flattening of the skull. It is also called flattened head syndrome. While positional plagiocephaly does not affect how a baby’s brain develops, it can affect a baby’s appearance. It can cause the baby’s head and face to develop unevenly.

Causes of positional plagiocephaly

Up until about 12 months of age, the bones of your baby’s head are thin and flexible. This makes your baby’s head very soft and easy to mold. Because a baby’s skull is soft, constant pressure on one part of the skull causes flattening. If your baby is always on his back or if your baby prefers to look in one direction, part of his skull may become flat.

Preventing positional plagiocephaly

Difference between and normal skull and positional flattening.To prevent your baby from developing a flattened skull, change his position often. Put your baby on his tummy to play several times a day. Use a firm play surface such as a carpeted floor or an activity mat on the floor.

“Tummy time” will also help your baby:

  • develop early control of his head
  • strengthen the muscles in his upper body
  • learn to roll over
  • reach for objects
  • learn to crawl

A part of your baby’s skull can become flattened if your baby is always on his back or prefers to look in one direction.

Baby playing during tummy time.How to make tummy time more enjoyable

Here are some ways to help your baby learn to love playtime on his tummy:

  • Lay your baby on your chest. This is a good way to get your baby used to lying on his tummy.
  • Put your baby on his tummy after each diaper change. Add a little extra tummy time each day.
  • Give your baby support by putting a rolled towel under his chest.
  • Prop your baby’s arms in front of the towel.
  • Give your baby lots of interesting things to look at while on his tummy. Put brightly coloured toys or a mirror directly in front of him.

Treating positional plagiocephaly

Baby laying on his side with support.If your baby has a flat spot, you may still be able to reshape it. You may want to talk to your doctor about repositioning your baby while he is awake and while asleep. This is called counter-positioning. To counter-position your baby, you will want to turn your baby slightly off his back at about a 45 degree angle. Use a firm crib roll to prevent your baby from rolling onto his tummy. This will take the pressure off the flat spot. You should continue this new position to keep your baby off the flat spot until his skull becomes round and even.

Counter-positioning works best when your baby is less than six months old. This is because the skull is still soft and your baby is more likely to remain in one position. Counter-positioning also encourages your baby to look to the less-preferred side.

What to do if your baby only looks in one direction

Baby laying on their side turning their head.If your baby prefers to look in one direction, encourage him to look to the less-preferred side until he looks equally in both directions. Here are some things you can do:

  • During playtime, use mobiles or brightly coloured toys to encourage your baby to look in the less-preferred direction
  • When you are holding your baby, hold him in a way to encourage him to look in the less-preferred direction
  • If your baby’s crib is against the wall, put your baby at opposite ends of the crib each night. Babies prefer to look out into the room.
  • If your baby’s crib is not against a wall, move a brightly coloured, crib-safe toy to encourage him to look in a different direction each night.

When to call the doctor

If you have followed the suggestions in this guide and you are still concerned about your baby’s head and neck, speak to your baby’s doctor to learn about other help available.

Some information about torticollis

Plagiocephaly and torticollis are closely associated with one another. After assessing your child’s head and neck, the therapist will design a home program for your baby. You may be given exercises and other recommendations.

Key points:

  • Positional plagiocephaly means flattening of the skull. It occurs when a baby lays on his back or looks in one direction for too long.
  • Putting your baby to play on his tummy several times a day can help prevent positional plagiocephaly.
  • If your baby has positional plagiocephaly, your doctor may recommend using a technique called counter-positioning to help correct the problem.
  • Positional plagiocephaly is sometimes associated with another condition called torticollis, which is when the muscle on one side of the neck is shorter than on the other side.

Adapted with permission from The Hospital for Sick Children

About Kids Health is a child health information website that provides parents, children and health care providers with free, evidence-based information about everyday health and complex medical conditions.