Plagiocephaly – What is it?

In broad terms Plagiocephaly is a condition characterised by a flattening on one side of the back of the head. It may also involve bulging of the forehead, fullness of the cheek and ear misalignment on the same side as the flattening.

There are three ‘typical’different head shapes:

locbandIn our experience there are two different forms of the condition: deformational and positional.

Deformational Plagiocephaly is caused by the stresses and strains of the birth process; this is confirmed by studies that have analysed new born babies as the incidence is raised amongst twins ,first born and males. The asymmetry is caused as the baby is born.

The second form is Positional Plagiocephaly and this occurs after birth. Main causes are prematurity(and therefore time spent supine in neo-natal unit), torticollis ,which is a medical condition and requires physiotherapy to loosen neck muscles but the primary cause is an unfortunate result of the Backs To Sleep campaign introduced in the early1990s to help prevent SIDS(Sudden Infant Death Syndrome).There seems to be a direct statistical link because of the measured increase in the incidence of Plagiocephaly after the campaign’s introduction. However because of the number of lives that have been saved by the Backs To Sleep campaign there is no suggestion that parents should ignore this advice.

The NHS and Plagiocephaly

In July 2007,the Department of Health told the House of Commons that there were no figures regarding the incidence of Plagiocephaly in the UK. The head shape of babies is not measured in the UK. Further the official NHS stance on Plagiocephaly is that the condition is purely a cosmetic issue, so it should be of no concern to Health Professionals. When parents raise the issue with either their GP or Health Visitor they are invariably told that:

  • It will go away naturally
  • If not hair will hide any asymmetry
  • It does not matter as it is not a medical problem

We have enough evidence from the volume of communications from parents of babies over the age of two to suggest that the Health Professionals are incorrect in one of their major assertions, namely that the condition will go away. .

The Incidence Of Plagiocephaly

As we have stated already there are no statistics in the UK. We are therefore reliant on data from other countries and invariably the sample sizes are too small for any certainty. We believe that the Netherlands provides the most reliable data because the Health Professions there do undertake what it calls Well Child Visits where head shapes are measured. In one such study in 1995 with a sample size of over 4,000 babies 9.9% were judged to have Plagiocephaly at six months of age.In another study at a General District Hospital in 2004/5 , 380 babies were measured within 48 hours of birth and then at seven weeks. At birth 6% of babies presented with Deformational Plagiocephaly. At seven weeks this had reduced to 2%.However 20% of babies developed Positional Plagiocephaly between birth and follow-up at seven weeks.

A recent Canadian study(July 2013) of 440 healthy infants found that 47% of babies aged 7-12 weeks had the condition. Of those 205 infants 22% were categorised as moderate or severe.

Prevention of Positional Plagiocephaly

Until 4-5 months of age repositioning and tummy time techniques may be enough to encourage either natural correction of head shape or prevention of the development of the condition. At night time alternate the end of the cot where the baby lays its head. Always turn the baby’s head so that it does not lie on the flattened side.

Tummy Timelocband2

During the day the baby should be encouraged to spend as much time as possible on its stomach.

Most babies dislike this initially as they do not have the strength to hold their head up. However, it is important to persevere and gradually build up the length of time spent on their tummy. This helps them build strength in their neck and trunk muscles.

Treatment of Positional Plagiocephaly

If repositioning techniques have not brought about sufficient improvement, then Cranial Remoulding Therapy is an option. The bands or helmets work by applying a gentle constant pressure over the areas of the baby’s skull which are most prominent while allowing unrestricted growth over the flattened areas. The band consists of a soft foam layer inside a thermoplastic shell. This allows for frequent adjustments during treatment in response to the changes in the baby’s head shape as treatment progresses.

Treatment is most effective in babies between 4-7 months old when the skull is still malleable. It takes between 3-6 months depending on the original severity of the asymmetry and the responsiveness of the individual baby. Babies up to the age of 18 months can be treated but treatment may take longer.

If you are concerned about the shape of your baby’s head

The London Orthotic Consultancy’s clinics in Bristol ,Cambridge,Cardiff, Exeter, Kingston, Leicester , Harley Street ( London) and Romford offer an initial, no obligation FREE consultation at which your baby’s head shape will be assessed, measured and treatment options discussed.

Contact: 020 8974 9989 or