Positional plagiocephaly, often called positional flat head syndrome, is a common condition where an infant’s skull develops a flattened area due to repeated external pressure. This occurs because a baby’s skull bones are soft and malleable during the first months of life. Plagiocephaly is a cosmetic issue that does not affect brain development or growth, but it does warrant professional attention for correction. This condition is fundamentally different from craniosynostosis, a rare and serious birth defect where the fibrous joints, or sutures, between the skull bones fuse prematurely, potentially restricting brain growth and requiring surgery.
Assessing Severity and Medical Consultation
A medical consultation with a pediatrician, physical therapist, or craniofacial specialist is the first step before beginning any treatment. These professionals diagnose and evaluate the severity of the flattening, often classifying it as mild, moderate, or severe, sometimes using the Cranial Vault Asymmetry Index (CVAI). The consultation involves visual inspection and precise measurements of the head, often using a caliper or a three-dimensional scanner, to quantify the degree of asymmetry. Timing is a factor in effective correction, as the skull is most responsive to change during the period of rapid brain growth, generally in the first year of life.
If the baby has a strong preference for turning their head to one side or a noticeable head tilt, the doctor may suspect associated torticollis. Torticollis is tightness in the neck muscles that requires specific physical therapy.
Repositioning and Active Physical Interventions
Active repositioning is the first line of defense for mild to moderate flattening. The goal is to keep pressure off the flat spot, allowing the skull’s natural growth to round out the area. This approach should be implemented as early as possible, especially before four to five months of age, when the skull is most easily molded.
Increasing supervised Tummy Time alleviates pressure from the back of the head while strengthening the neck, shoulder, and upper body muscles. Parents should aim for 30 to 60 minutes of Tummy Time daily, broken up into short, frequent sessions. During awake time, holding the baby often and avoiding prolonged periods in restrictive devices like car seats, swings, and bouncy seats is recommended to reduce consistent pressure on the skull.
Counter-positioning techniques should be used while the baby is sleeping on their back. This involves positioning the baby so they naturally turn their head toward the non-flattened side, such as by changing the crib’s orientation. When holding, feeding, or carrying the baby, parents should alternate sides to distribute forces on the head more evenly. If torticollis is present, a physical therapist will prescribe specific neck stretching and strengthening exercises, as repositioning alone may not be effective.
Understanding Cranial Remolding Helmets
When conservative repositioning measures do not achieve sufficient correction, a cranial remolding orthosis, commonly called a helmet, may be prescribed. The helmet works by capitalizing on the rapid growth of the infant’s brain and skull, which nearly doubles in size during the first six months of life. The custom-fitted helmet applies gentle, passive pressure to the prominent areas while leaving a space over the flattened area.
This mechanism redirects natural head growth into the open space, encouraging the flat spot to round out. Optimal results are seen when treatment begins between four and six months of age, though it can be effective up to 18 months, often requiring a longer treatment duration. The typical duration of treatment averages three to five months, and the helmet must be worn for approximately 23 hours per day, removed only for bathing and brief skin checks.
Fabrication of the custom helmet begins with a 3D scan of the baby’s head. Follow-up appointments with the orthotist are scheduled frequently, typically every two to four weeks, for ongoing monitoring, measurements, and adjustments as the baby’s head grows. Parents are instructed on proper hygiene to prevent skin irritation and must follow a break-in schedule.
Long-Term Prevention Strategies
After the initial correction phase, maintaining good head shape involves incorporating mindful practices into daily routines to prevent recurrence. A significant focus is on minimizing the time an infant spends in devices that restrict movement and place constant pressure on the back of the head. Car seats, swings, and baby carriers are helpful tools, but extended use should be limited, especially when the baby is awake.
Maximizing awake time outside of these restrictive devices is an effective strategy to encourage free movement and varied head positions. Holding, carrying, and engaging the baby in different positions throughout the day naturally relieves pressure points and strengthens neck muscles. Establishing good sleeping habits post-correction involves alternating the baby’s head position when they are placed in the crib to avoid a preference for one side. Continuing to incorporate Tummy Time into the daily routine supports the baby’s overall motor development.