Plagiocephaly, often called “flat head syndrome,” is a common condition where an infant develops an asymmetrical or flattened head shape due to external pressure on the soft skull bones. This positional flattening is generally a cosmetic issue that does not affect brain development, but it does require attention. Determining the appropriate path of care depends on the severity of the flattening and the baby’s age, requiring a collaborative effort involving several distinct healthcare professionals. Early identification is important because the most effective treatments rely on the rapid growth of the infant skull during the first year of life.
The Primary Care Provider’s Role
The first professional to assess a baby’s head shape is typically the Pediatrician or Family Doctor during routine well-child visits. These primary care providers are responsible for initial screening and differentiating between common positional plagiocephaly and the more serious condition of craniosynostosis. Craniosynostosis involves the premature fusion of skull plates and requires surgical correction, making this initial distinction critical.
If the flattening is mild and positional, the doctor recommends conservative first-line treatments. These focus on environmental changes, such as increasing supervised “tummy time” to strengthen neck muscles and relieve pressure on the back of the head. They also advise parents on repositioning techniques, encouraging the baby to turn their head away from the flattened side. If the condition persists or worsens, the primary care provider refers the family to specialists for more intensive treatment.
Specialists for Repositioning and Physical Therapy
For many infants with plagiocephaly, a tight neck muscle condition called congenital muscular torticollis is a contributing factor. Torticollis causes the baby to consistently hold their head tilted or turned to one side, constantly putting pressure on the same area of the skull. Physical Therapists (PTs) and sometimes Occupational Therapists (OTs) become involved in the treatment plan here.
The PT evaluates the baby’s neck range of motion, muscle strength, and overall motor development. Their goal is to stretch and release the tightened sternocleidomastoid muscle, restoring full, symmetrical movement. They use gentle, play-based exercises and teach parents a specific regimen of stretching and positioning techniques to perform daily at home. Early physical therapy intervention is effective, often preventing the worsening of the head shape and promoting better motor skill development.
The Orthotist and Cranial Remolding
When conservative measures like repositioning and physical therapy do not achieve sufficient correction, especially in moderate to severe plagiocephaly, the Orthotist steps in. An Orthotist is a specialist trained in the design, fabrication, and fitting of the custom cranial remolding orthosis, often called a helmet or band. This device is a passive form of treatment that works by gently guiding the skull’s growth.
The process begins with the Orthotist using digital scanning technology to create a precise, three-dimensional model of the baby’s head. The custom-fabricated helmet applies total contact to the prominent areas of the skull while leaving space over the flattened areas. The baby’s natural, rapid brain growth, particularly between four and six months of age, then pushes the skull into the open space, rounding the head over several months of wear. The Orthotist manages the treatment schedule, which typically involves wearing the helmet up to 23 hours a day, and conducts follow-up appointments every two to four weeks for adjustments.
Advanced Diagnostic and Surgical Teams
In rare cases, or when the initial diagnosis is uncertain, the child may be referred to a specialized team that includes Pediatric Neurosurgeons and Craniofacial Surgeons. These physicians are necessary to definitively rule out craniosynostosis, a condition that requires surgical treatment. They perform detailed physical examinations and may order advanced imaging, such as a low-dose computed tomography (CT) scan, to visualize the skull sutures and confirm whether they have prematurely fused.
If craniosynostosis is confirmed, the Neurosurgeon and Craniofacial Surgeon collaborate to perform surgery to release the fused sutures, allowing the brain to grow normally and reshaping the skull. Surgical options can range from minimally invasive endoscopic procedures, often followed by helmet therapy, to more traditional open cranial vault remodeling. The expertise of this surgical team manages the most complex and medically significant head shape differences.