What is Deformational Plagiocephaly?
Deformational or positional plagiocephaly refers to a mishapen (asymmetrical) shape of the head (cranium) from repeated pressure to the same area of the head. Plagiocephaly literally means "oblique head" (from the Greek 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. (see diagram) 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 and/or a neurosurgeon. An x-ray and/or CT of the head is usually required to make the diagnosis.
In deformational plagiocephaly there is not fusion of the skull sutures. It is a clinical diagnosis made after a thorough medical history and physical examination by a craniofacial or neurosurgeon. X-rays and/or CT studies are usually not necessary.
| Craniosynostosis | Deformational Plagiocephaly |
| asymmetric head | asymmetric head |
| results from internal events | results from external molding |
| premature fusion of cranial suture(s) | normal cranial sutures |
| diagnosis made with x-ray studies | diagnosis usually made without (CT, etc..) xray studies |
| treatment is surgery | treatment is positioning and/or helmeting |
| cause is unknown | causes: back sleeping, restrictive intrauterine environment, torticollis, prematurity |
How does deformational plagiocephaly occur? (or what is the cause?)
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 breech position.
Another risk factor for deformational plagiocephaly is muscular torticollis. This is a congenital (present at birth) finding where 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 their head against the mattress in the same position repeatedly.
Premature infants are at a higher risk for plagiocephaly since the cranial bones become stronger/harder in the last ten weeks of pregnancy. Also, since many such infants spend extended periods of time in the neonatal intensive care (NICU) unit on a respirator, their head is maintained in a fixed position.
Infants who sleep on their back or in car seats without alternating positions for extended periods of time are also at a higher risk for deformational plagiocephaly.
Is deformational plagiocephaly becoming more common?
In 1992, the American Academy of Pediatrics (AAP) recommended
infants sleep either on their backs or sides to reduce the risk of Sudden
Infant Death Syndrome (SIDS). Since then medical providers have noted a
significant increase in the number of infants presenting with
non-synostotic plagiocephaly. These deformations are positional in
nature, because of the extended time an infant spends lying supine (on
their back) in a crib, car seat or infant swing.
What is the treatment for deformational 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
help prevent and treat positional plagiocephaly. Frequent rotation of
your child’s head would be the first recommendation once your infant
has been diagnosed with plagiocephaly. Some cases do not require any
treatment and it may resolve spontaneously when the infant begins to sit.
If the deformity is moderate to severe and a trial of
re-positioning has failed, your medical provider may recommend a cranial
remodeling band or helmet.
How does helmeting correct deformational plagiocephaly?
These devices are usually made of an outer hard shell with a foam
lining. Mild pressures are applied to capture the natural growth of an
infant’s head inhibiting growth in the prominent areas and allowing
for growth in the flat regions. Adjustments as the head grow are made
frequently. It essentially provides a tight, round space for the head to
grow into.
How long will my child wear this device?
The average treatment is usually 3-6 months, depending on the age
of the infant and the severity of the condition. Each patient’s
treatment is custom designed.
Can I buy these helmets at a children’s store?
These devices must be prescribed by a licensed physician with
craniofacial experience.
