Plagiocephaly: “Flat head syndrome”
A well-known condition in infants, plagiocephaly occurs when part of a baby’s head becomes flattened or misshaped. Find out how this common condition is identified and treated.
A well-known condition in infants, plagiocephaly occurs when part of a baby’s head becomes flattened or misshaped. Find out how this common condition is identified and treated.
What is plagiocephaly?
Plagiocephaly, or flat head syndrome, is when a baby develops a flat area on the front, back, or side of their head. This condition is common in infants, and can be readily treated in several different ways.
You may also see plagiocephaly referred to as a “cranial deformity,” which simply means that a baby’s head has grown into an abnormal shape. There are several different types of this condition, all of which can occur for several different reasons — and all of which can be safely and gently corrected with the right care team and treatment.
How babies develop flat head syndrome
Babies are born with soft, pliable areas in their skull that slowly fuse together during the first few years of growth. During that time, an infant’s skull can be gradually misshaped when a baby stays in the same position for long periods of time.
That’s why you will often read about “positional” plagiocephaly: it usually occurs when a baby spends long periods in certain positions before or after birth. Over time, pressure on a baby’s soft, flexible skull can gradually push it out of its natural shape.
This is different from craniosyntosis, or congenital plagiocephaly, which occurs when a baby’s skull fuses too early in an abnormal shape. With positional plagiocephaly, a baby’s skull can often grow back into the right shape over time with the right care.
Here are several of the different factors than can contribute to the development of flat head syndrome:
Conditions in the womb
Twins and triplets grow in confined conditions that can increase their risk of plagiocephaly. Some birth complications can also be a risk factor. Premature babies also typically have very soft skulls that are prone to developing this condition.
Twins and triplets grow in confined conditions that can increase their risk of plagiocephaly. Some birth complications can also be a risk factor. Premature babies also typically have very soft skulls that are prone to developing this condition.
Back sleeping
Babies that sleep facing up can be at higher risk of plagiocephaly. This is still the safest way for babies to sleep, as it reduces the risk for sudden infant death syndrome (SIDS).
Babies that sleep facing up can be at higher risk of plagiocephaly. This is still the safest way for babies to sleep, as it reduces the risk for sudden infant death syndrome (SIDS).
Seats & carriers
Some babies may spend long periods in a car seat, lounger, swing, or stroller. Resting their head against these devices for long periods of time can gradually result in a baby developing flat head syndrome.
Some babies may spend long periods in a car seat, lounger, swing, or stroller. Resting their head against these devices for long periods of time can gradually result in a baby developing flat head syndrome.
Physical conditions
Muscular torticollis and kinematic imbalance due to subocciptal strain (KISS) can both cause an infant’s neck muscles to tighten and clench. This tightness can sometimes keep a baby’s head stuck in one position.
Muscular torticollis and kinematic imbalance due to subocciptal strain (KISS) can both cause an infant’s neck muscles to tighten and clench. This tightness can sometimes keep a baby’s head stuck in one position.
Risks for affected infants
Many infants with positional plagiocephaly will grow out of the condition as they try new sleeping positions and become more active. But in some more severe or untreated cases, flat head syndrome can impact a baby’s body and health in several ways:
Facial differences: Plagiocephaly can give a child abnormal facial features or an uneven head shape, including bulged eyes or misaligned eyes, ears, teeth, or cheekbones.
Practical challenges: Left uncorrected, an abnormal head or face shape may make it difficult for some children to wear glasses, some sportswear, or protective gear they may need later in life.
Psychosocial difficulties: Children with an unusual head shape or facial features may be more at risk for teasing, bullying, or other negative social experiences that may affect their self-esteem, confidence, or emotional wellbeing.
Developmental delays: Some medical research suggests that plagiocephaly may potentially delay some babies’ development of motor, language, and social skills. [1,2]
The different kinds of flat head syndrome
Depending on which position a baby stays in most, they may develop one of several different types of this condition. Here’s a closer look at the most common forms.
Plagiocephaly
The most common form flat head syndrome, this type occurs when an infant develops a flat spot on one side of their head. This can give the baby’s skull and face an uneven, asymmetrical appearance.
The most common form flat head syndrome, this type occurs when an infant develops a flat spot on one side of their head. This can give the baby’s skull and face an uneven, asymmetrical appearance.
Brachycephaly
This form occurs when an infant develops a flat spot on the back of their head. Babies with brachycephaly often have heads that look unusually wide and tall. Their ears may stick out, and their face may look small relative to their head.
This form occurs when an infant develops a flat spot on the back of their head. Babies with brachycephaly often have heads that look unusually wide and tall. Their ears may stick out, and their face may look small relative to their head.
Asymmetrical brachycephaly
A flat spot on the back of a baby’s head can sometimes develop at an angle to the skull. When this occurs, it can shift the baby’s skull into an oblong shape that pushes the baby’s ears, eyes, and cheekbones out of natural alignment.
A flat spot on the back of a baby’s head can sometimes develop at an angle to the skull. When this occurs, it can shift the baby’s skull into an oblong shape that pushes the baby’s ears, eyes, and cheekbones out of natural alignment.
Scaphocephaly
This form typically occurs when a baby spends long periods sleeping on their side. This can give their head an unusually long, narrow shape. It’s most common in premature babies who are positioned on their side for treatment in a NICU.
This form typically occurs when a baby spends long periods sleeping on their side. This can give their head an unusually long, narrow shape. It’s most common in premature babies who are positioned on their side for treatment in a NICU.
How plagiocephaly is identified
Plagiocephaly, brachycephaly, and scaphocephaly all typically develop in the first year of an infant’s life. Early signs of flat head syndrome may start to appear as early as 6-8 weeks after birth, but often become more noticeable once a baby is several months old.
These conditions can be identified in several different ways, depending on how severe the baby’s plagiocephaly has become. Parents or caregivers may notice that a baby’s head has started to take on an abnormal shape, and bring up their concerns to their pediatrician. Or, during a routine checkup, the pediatrician or a pediatric nurse may notice that a baby is showing signs of plagiocephaly and recommend steps to address their head shape.
Regardless of when and where the signs appear, only a medical professional can officially diagnose plagiocephaly, brachycephaly, or scaphocephaly. That diagnosis typically requires a few simple steps, including a physical exam and reviewing the baby’s medical history. At that point the baby’s doctor may recommend one of several different approaches, including a specialized orthotic device designed to correct flat head syndrome.
Correcting a baby’s head shape
While plagiocephaly, brachycephaly, and scaphocephaly may look concerning, they can be effectively treated in a number of gentle, non-invasive ways. Many babies with flat head syndrome may simply need to spend more time in different positions. Other children may need to see a physical therapist, especially if their head shape is related to a muscular issue. Or, they may also need a special orthosis.
Many of these therapies are most effective between 4 to 8 months after birth, so it’s important to start treatment as soon as a doctor recommends it.
Changing a baby’s resting position can help reduce pressure on flat parts of their head. More “tummy time” can give the baby’s head a chance to naturally grow into a normal shape.
Changing a baby’s resting position can help reduce pressure on flat parts of their head. More “tummy time” can give the baby’s head a chance to naturally grow into a normal shape.
This is often the first step for babies who need clinical treatment for plagiocephaly. Stretching and exercise can help release muscle tension and encourage head movement.
This is often the first step for babies who need clinical treatment for plagiocephaly. Stretching and exercise can help release muscle tension and encourage head movement.
Sometimes called a “baby helmet,” these specialized medical devices are used to help gently reshape a baby’s head over time.
Sometimes called a “baby helmet,” these specialized medical devices are used to help gently reshape a baby’s head over time.
What to know about CROs
These special orthoses are designed to help adjust the shape of an infant’s skull. They can be produced in several different ways, including traditional foam helmets and lightweight, 3D-printed devices.
CROs treat plagiocephaly using a combination of design features: contact zones that define gentle limits for growth and growth zones that leave space in areas needed to form a natural head shape. To deliver that result, a CRO typically needs to be worn 23 hours a day for 3 to 6 months.
Every CRO is customized for the unique baby that will wear it, so it must always be prescribed by a doctor and carefully designed by a trained orthotist. Babies also need regular checkups during treatment, so it’s important to work with specialist who can monitor your child’s progress and adapt their device if required.
MyCRO Band
This thin, lightweight device is one of today’s most advanced CROs. Built with state-of-the-art 3D scanning and printing technology, it features a self-expanding closure system that minimizes the need for adjustments, as well as a washable inner lining that helps keep baby comfortable.
Get more information about plagiocephaly.
Want to learn more about flat head syndrome or explore potential treatment options? Check out these helpful resources or reach out to our Ottobock team.
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Think your child may have signs of flat head syndrome? Interested in MyCRO Band treatment? Search a list of Ottobock orthotics centers for a clinic near you.
Think your child may have signs of flat head syndrome? Interested in MyCRO Band treatment? Search a list of Ottobock orthotics centers for a clinic near you.
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References:
1. Rohde JF, Goyal NK, et al. Association of Positional Plagiocephaly and Developmental Delay Within a Primary Care Network. J Dev Behav Pediatr. 2021 Feb-Mar;42(2):128-134.
2. Martiniuk AL, Vujovich-Dunn C, Park M, Yu W, Lucas BR. Plagiocephaly and Developmental Delay: A Systematic Review. J Dev Behav Pediatr. 2017 Jan;38(1):67-78.