Deformational (or positional) plagiocephaly refers to a misshapen (asymmetrical) shape of the head (cranium) from repeated pressure to the same area of the head. Plagiocephaly literally means oblique head, from the Greek words plagio for oblique and cephale for head.
Craniosynostosis is premature fusion of one or more of the sutures in the skull. True synostosis may limit the size of the cranial vault (skull) and therefore impair brain growth. The diagnosis is made after a clinical evaluation by a craniofacial surgeon and/or a neurosurgeon. X-rays and CT scans of the head may be performed to confirm the diagnosis of craniosynostosis. Surgery is usually the recommended treatment.
In deformational plagiocephaly, there is no fusion of the skull sutures. It is a clinical diagnosis made after a thorough medical history and physical examination by a craniofacial surgeon or neurosurgeon. X-rays and/or CT scans are usually not necessary. Treatment of deformational plagiocephaly generally includes positioning and/or helmeting.
The major differences between craniosynostosis and deformational plagiocephaly are summarized in the chart below:
May include back sleeping, restrictive intrauterine environment, muscular torticollis, and prematurity
By keeping an infant's head in one position for long periods of time, the skull flattens (external pressure). Occasionally, a baby is born with this flattening because of a tight intrauterine environment (for example, in multiple births, small maternal pelvis, or with a breech position). Other factors which may increase the risk of deformational plagiocephaly include the following:
Specific treatment will be determined by your child's doctor based on the severity of the deformational plagiocephaly. Frequent rotation of your child's head would be the first recommendation once your infant has been diagnosed with plagiocephaly. Alternating your infant's sleep position from the back to the sides, and not putting infants on their backs when they are awake may also help prevent and treat positional plagiocephaly. Some cases do not require any treatment and the condition may resolve spontaneously when the infant begins to sit.
If the deformity is moderate to severe and a trial of repositioning has failed, your child's doctor may recommend a cranial remodeling band or helmet.
Helmets are usually made of an outer hard shell with a foam lining. Gentle, persistent pressures are applied to capture the natural growth of an infant's head, while inhibiting growth in the prominent areas and allowing for growth in the flat regions. As the head grows, adjustments are made frequently. The helmet essentially provides a tight, round space for the head to grow into.
The average treatment with a helmet is usually three to six months, depending on the age of the infant and the severity of the condition. Careful and frequent monitoring is required. Helmets must be prescribed by a licensed health care provider with craniofacial experience.
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The Craniofacial Program at Children’s National brings together experts from 10 pediatric disciplines to provide complete care for children with craniofacial disorders. Our multidisciplinary pediatric team helps more than 400 children every year.