Plagiocephaly, often called “flat head syndrome,” describes an asymmetrical distortion where a baby’s skull develops a flattened area, usually on one side of the back of the head. This condition is common, largely due to external pressure on the soft, malleable skull bones. Since the “Back to Sleep” campaign encouraged infants to sleep on their backs to reduce Sudden Infant Death Syndrome (SIDS) risk, the incidence of this positional head flattening has increased. Successful management requires a coordinated effort from a team of specialists who guide families through treatment options based on severity and underlying cause.
Initial Diagnosis and Screening
The process of diagnosis and initial management typically begins with the primary care provider, the pediatrician or family doctor, during routine well-baby visits. They perform a thorough physical examination to assess the baby’s head shape symmetry and size, tracking growth against standardized charts. This initial assessment is important for distinguishing between positional plagiocephaly, caused by external pressure, and craniosynostosis, a more serious condition involving the premature fusion of skull sutures.
If a mild flattening is noted, the doctor usually recommends conservative measures first, such as repositioning strategies. These focus on minimizing the time the infant spends lying on the flattened spot during awake and supervised periods. Doctors also look for an underlying cause like muscular torticollis, where tight neck muscles cause the baby to consistently favor turning their head to one side. If repositioning does not resolve the flattening or if the case is moderate to severe, the pediatrician initiates referrals to specialists for further evaluation.
Physical and Occupational Therapy Specialists
Physical Therapists (PTs) and Occupational Therapists (OTs) play an active role, particularly when head flattening is associated with torticollis. Since torticollis limits the infant’s ability to turn their head, it perpetuates positional flattening. These therapists evaluate the baby’s range of motion, muscle tightness, and overall motor development.
Treatment involves a targeted program of stretching and strengthening exercises designed to restore full, symmetrical neck movement. Therapists teach parents specific stretches for the tight sternocleidomastoid muscle and activities that encourage the infant to actively turn their head toward the non-preferred side. They also provide instruction on environmental modifications, such as positioning toys and the crib to encourage turning the head off the flattened side. Maximizing supervised tummy time is also a part of this therapy, strengthening neck and upper body muscles while alleviating pressure on the back of the head.
The Orthotist and Cranial Remolding
If repositioning and physical therapy are insufficient for correcting moderate to severe plagiocephaly, typically after a few months of conservative treatment, a Certified Orthotist specializing in cranial care becomes involved. The orthotist designs, fits, and manages the cranial remolding orthosis, often called a “helmet” or “cranial band.” This custom-fabricated device works by applying gentle pressure to the prominent areas of the skull while leaving space for growth in the flattened regions.
The process begins with a precise 3D scan of the baby’s head, which provides the data for the customized design. This device works best during the period of rapid head growth, optimally between four and six months of age. The orthotist monitors the infant closely through weekly or bi-weekly appointments to make adjustments, ensuring the helmet fits correctly and the head is reshaping properly. Treatment generally requires the infant to wear the orthosis for up to 23 hours a day over several months, with the orthotist managing the fit and ensuring skin health.
Surgical and Craniofacial Consultation
A consultation with a specialized medical doctor is required in a small number of cases to rule out craniosynostosis, where the skull sutures fuse prematurely. This consultation involves a pediatric neurosurgeon or a craniofacial plastic surgeon. These specialists definitively diagnose and treat craniosynostosis, which is a structural issue requiring surgery.
The surgeon uses physical examination and sometimes advanced imaging, such as CT scans, to confirm if any sutures are fused. Surgical intervention aims to open the prematurely closed sutures, allowing the brain to grow without restriction and correcting the head shape. This treatment is reserved for cases where the underlying issue is bone fusion. The neurosurgeon or craniofacial surgeon often works collaboratively with a plastic surgeon on a multidisciplinary team to provide the best possible outcome.