Deformational Plagiocephaly

What is deformational plagiocephaly?

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.

How is deformational plagiocephaly different from craniosynostosis?

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:

Deformational plagiocephaly
Head shape
Asymmetrical head
Asymmetrical head
Results from
Internal events
External molding
Fusion of cranial sutures
Premature fusion of cranial suture(s)
Normal cranial sutures
Made with X-rays and CT scans
Usually made without X-rays and other imaging studies
Positioning and/or helmeting

May include back sleeping, restrictive intrauterine environment, muscular torticollis, and prematurity



What causes deformational plagiocephaly?

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:

  • Muscular torticollis. One cause of deformational plagiocephaly may be muscular torticollis. Muscular torticollis is a congenital (present at birth) finding in which one or more of the neck muscles is extremely tight, causing the head to tilt and/or turn in the same direction. Torticollis is often associated with the development of plagiocephaly since the infant holds his or her head against the mattress in the same position repeatedly.
  • Prematurity. Premature infants are at a higher risk for plagiocephaly since the cranial bones become stronger and harder in the last 10 weeks of pregnancy. Also, since many premature infants spend extended periods of time in the neonatal intensive care unit on a respirator, their heads are maintained in a fixed position, increasing the risk for this condition.
  • Back sleeping. Infants who sleep on their backs or in car seats without alternating positions for extended periods of time are also at a higher risk for deformational plagiocephaly.
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