Pediatric Plagiocephaly

What Is Plagiocephaly?

Plagiocephaly describes a condition in which a baby’s skull is flattened on one side of the back or front of the head. Plagiocephaly can be congenital (present at birth) or develop during infancy (positional or deformational).

Positional plagiocephaly does not usually cause serious complications. If congenital plagiocephaly, which is caused by craniosynostosis, is left untreated, it can lead to serious complications, including:

• Head deformities, possibly severe and permanent
• Increased pressure inside the head
• Seizures
• Developmental delay

What Causes Plagiocephaly?

Positional plagiocephaly develops when a baby often sleeps on his or her back, creating a flat area. Congenital plagiocephaly is caused by craniosynostosis, a condition in which sutures (joints) between an infant’s skull bones grow together too early.

The causes of congenital plagiocephaly are usually unknown if it appears without any other symptoms. It can be part of a genetic syndrome, such as Pfeiffer or Crouzon, with symptoms and problems in other parts of the body.

Types of Plagiocephaly

The two types of plagiocephaly are:

• Positional: Most common, caused by sleep position
• Congenital: Caused by the closing of a coronal suture that runs from the top of the head toward either ear (craniosynostosis)

Symptoms of Plagiocephaly

Symptoms of plagiocephaly differ depending on which type your child may have. Common symptoms of the positional type may include:

• Flattening on one side of the back of the head
• Ear pushed forward on the same side of the head
• Head tilted to one side
• Bulging forehead on the same side of the head
• Facial abnormalities including uneven cheekbones, eye sockets, or lower jaw

Symptoms of congenital plagiocephaly include:

• Missing, full, or bulging "soft spot" (fontanel) on the newborn's skull
• Bony ridges along the affected sutures
• Facial abnormalities including bulging forehead and brow on one side, uneven cheekbones, eye sockets, or lower jaw
• Prominent blood vessels in the scalp
• Poor feeding or projectile vomiting
• Seizures

How Is Plagiocephaly Diagnosed?

If your baby has a misshapen head, your pediatrician will need to determine whether it is caused by sleep position or craniosynostosis. With a physical exam of your child’s head, the physician can usually distinguish the two conditions.

At Children’s National, we may use one or more of these tests to confirm craniosynostosis:

• X-rays to check for fused (missing) sutures or ridges along sutures
• Diagnostic imaging, especially CT scans, also to check for fused sutures or ridges along sutures
• Genetic tests to check for syndromes that cause craniosynostosis

Treatments for Craniosynostosis

Most babies with positional plagiocephaly need only minor treatment, such as:

• Repositioning for sleep, so that the baby moves his or her head more often
• Increased “tummy time” to improve neck strength and range of motion
• Helmet therapy to reshape the skull for more severe cases

For plagiocephaly caused by craniosynostosis, treatment goals focus on correcting skull shape to relieve pressure inside the head and ensure enough room for the brain to grow. At Children’s National, we may recommend one or more of the following treatment options:

• Surgery before age 1 to open skull sutures for normal skull and brain growth
• Helmet therapy to reshape the skull