Deformational (or positional) plagiocephaly refers to a misshapen (asymmetrical) head (cranium) from continued pressure on the same area of the head. Plagiocephaly literally means "oblique head" (from the Greek words "plagio" for oblique and "kephale" for head).

Craniosynostosis is premature fusion of one or more of the sutures in the skull. 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 surgeon and/or a neurosurgeon. X-rays and CT scans of the head may be performed to confirm the diagnosis of craniosynostosis. Surgery is usually the recommended treatment for craniosynostosis.

In deformational plagiocephaly, there is no fusion of the skull sutures. It is a clinical diagnosis made after a thorough medical history and physical examination by a craniofacial surgeon and/or neurosurgeon. X-rays and/or CT scans are usually not necessary. Treatment of deformational plagiocephaly generally includes positioning, physical therapy, and/or helmeting. Causes are unknown but may include back sleeping, restrictive intrauterine environment, muscular torticollis, and prematurity.

Muscular torticollis is a congenital finding in which one or more of the neck muscles is tight. This causes the head to tilt and/or turn in the same direction. Torticollis is often associated with the development of plagiocephaly since the infant holds his/her head against the mattress in the same position.

Premature infants are at a higher risk for plagiocephaly since the cranial bones become stronger and harder in the last 10 weeks of pregnancy.

Infants who sleep on their backs, or in car seats without alternating positions for extended periods of time are also at a higher risk for deformational plagiocephaly.

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 deformational or positional plagiocephaly. These deformations are positional in nature, because of the extended time an infant spends lying supine (on his/her back) in a crib, car seat, or infant swing.

Treatment of Deformational Plagiocephaly

The physician will prescribe specific treatment based on the severity of the deformational plagiocephaly. Frequent rotation of your child's head would be the first recommendation. Some cases do not require any treatment and the condition 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 child's physician may recommend a cranial remodeling band or helmet. The course of treatment may also depend on the age at which the diagnosis is made.

How does helmeting correct deformational plagiocephaly?

Helmets are usually made of an outer hard shell with a foam lining. The lining is more full in the prominent areas of the head. This inhibits growth in those prominent areas while allowing growth in the flatter regions. As the head grows, adjustments are made frequently. The helmet essentially provides a tight, round space for the head to grow into.

How long will my child wear a helmet?

The average treatment with a helmet is usually three to six months, depending on the age of the infant and the severity of the condition. Careful and frequent monitoring is required. Helmets must be prescribed by a licensed physician with craniofacial experience.