Tessa Irwin, PT, DPT
Lead Physical Therapist
What is Plagiocephaly?
Plagiocephaly is the flattening of the skull on one side. It can be accompanied by facial asymmetries as well including forehead bulge on one side, jaw or cheek asymmetries, or asymmetrical eye sockets.
What are the signs and what does it look like?
An infant's skull is moldable; so with positioning in the womb, sleeping position, torticollis, etc. parents may notice an abnormal head shape. Any prolonged positioning that applies an asymmetrical force to the skull may put the infant at risk for an abnormal head shape. Plagiocephaly frequently occurs with children who have a diagnosis of Torticollis, the shortening of one or more of the muscles of the neck that tilt or rotate the head, and have a rotational preference. If an infant spends the majority of the time looking only to one side while they are lying on their back, they will be at risk for flattening on that side of their head.
How is plagiocephaly diagnosed?
Plagiocephaly is diagnosed by a physician or physical therapist, usually by visual assessment coupled with medical history, cervical range of motion testing, and gross motor assessment.
What can a parent(s) do?
After speaking with their child's physician and/or therapist, they can begin a home program of positioning and strengthening. Tummy-time will be incredibly important in developing strong cervical muscles, but your therapist will also talk to you about different ways to position your child while carrying them, during feeding, and positioning during snuggle time. It is important for a physician or therapist to get a detailed medical history, an idea of home environment, and an idea of routine so that the infant's home exercise program can be tailored to them. If an infant only presents with plagiocephaly, the therapist might educate them on the risks of torticollis and what to look out for. If the child also has a torticollis diagnosis, stretching and strengthening exercises will also be added to the home program.
What is the outlook and treatment for plagiocephaly?
Treatment for plagiocephaly will depend on the severity, age of the child, and if torticollis or other musculoskeletal disorders are diagnosed. Typically, the earlier the diagnosis, the less invasive treatment is required. The infant's skull sutures do not fuse fully until around 18 months, although 80% occurs before the age of 12-months (1). Clinically, we have seen early, intensive positioning programs to work well with our young infants. If plagiocephaly persists, the child may need a referral for a cranial scan to assess the degree of asymmetry. The child may also require a cranial orthosis (a plagiocephaly helmet) to assist in reshaping their head.
Recommended References to Learn More:
Always consult your child’s physician first if you think your child may have plagiocephaly or torticollis. References are for informational purposes only and they are not intended to replace physician and/or physical therapy treatment(s).
(1) Palisano RJ, Campbell SK, Orlin M. Physical Therapy for Children. Elsevier Health Sciences; 2014.