What Is Plagiocephaly (Flat Head / Asymmetrical Head)?

Plagiocephaly describes flattening on one side of the back or front of a baby’s skull. It may be present at birth (congenital) or develop in infancy (positional or deformational).

Positional plagiocephaly usually does not cause serious complications. Congenital plagiocephaly associated with craniosynostosis can lead to serious problems if untreated:

• Head deformities and shape concerns (possibly severe and lasting)
• Increased pressure inside the head
• Seizures
• Developmental delay

• What causes plagiocephaly?
• Types of plagiocephaly
• Symptoms of plagiocephaly
• How is plagiocephaly diagnosed?
• Plagiocephaly treatments
• Let’s evaluate your baby’s head shape – apply for a preliminary assessment

What Causes Plagiocephaly?

Positional plagiocephaly usually develops when a baby spends a lot of time on the back, creating a flat area in that region.

Congenital plagiocephaly is caused by craniosynostosis, in which sutures (joints) between skull bones grow together too early.

When congenital plagiocephaly appears without other symptoms, causes are often unknown. With symptoms elsewhere in the body, it may be part of a genetic syndrome such as Pfeiffer or Crouzon.

Types of Plagiocephaly

There are two types:

• Positional: The most common type, related to sleep position. For other positional head deformities, see our positional scaphocephaly article.
• Congenital: Caused by early closing of a coronal suture running from the top of the head toward each ear (craniosynostosis).

Symptoms of Plagiocephaly

Symptoms vary by type.

Common signs 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 of the forehead on the same side
• Facial differences including uneven cheekbones, eye sockets, or lower jaw

How Is Plagiocephaly Diagnosed?

If your baby’s head looks misshapen, the pediatrician needs to determine whether it is from sleep position or craniosynostosis. Physical examination of the head usually distinguishes the two.

To confirm craniosynostosis, your doctor may order one or more of these tests:

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

Plagiocephaly Treatments

Most babies with positional plagiocephaly need only simple care, for example:

• Repositioning for sleep so the baby moves the head more often
• Increased tummy time to improve neck strength and range of motion. See our Tummy Time guide.
• For more serious cases, helmet therapy to reshape the skull—fitted only at CranioWell Orthotics & Prosthetics Centers

For plagiocephaly caused by craniosynostosis, treatment aims to correct skull shape, reduce pressure inside the head, and leave enough room for brain growth. One or more of the following may be recommended:

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