Plagiocephaly or flat head

Plagiocephaly is a common condition that concerns many parents. Have you noticed that your baby's head seems flattened on one side? Rest assured, this condition responds very well to early intervention. As pediatric physiotherapists, we regularly support families in this situation. Here's what you need to know to act effectively.

What is plagiocephaly in babies?

Plagiocephaly is a flattening on one side of the back of an infant's skull, often accompanied by a bulging of the forehead on the same side. This condition affects approximately 20% of newborns to varying degrees.

The term comes from the Greek words "plagios" (oblique) and "kephalê" (head). Rarely present at birth, plagiocephaly usually appears between the first and fourth month of life.

There are two distinct types:

The good news is that positional plagiocephaly does not limit your child's brain development. In the vast majority of cases, the head regains its normal shape before the age of 2. The impact is primarily cosmetic if the condition is pronounced and left untreated.

What causes a flat head?

Plagiocephaly is mainly caused by a lack of varied positions during awake periods. It can also be linked to a difficult birth, prematurity, or the presence of congenital torticollis.

Plagiocephaly is very often associated with congenital torticollis. In fact, 70 to 90% of babies with plagiocephaly also present with torticollis. These two conditions must be evaluated and treated together to achieve the best results.

Since the "Back to Sleep" campaign to prevent sudden infant death syndrome, the incidence of plagiocephaly has increased. The solution is not to put babies on their stomachs to sleep, but rather to vary their positions during awake periods.

How to recognize plagiocephaly?

Observe your baby from above while they are sitting on your lap. Place them sitting on your legs, facing you, then look at the top of their head. You will be able to clearly see the shape of the skull.

Certain behaviors also suggest a positioning problem or associated torticollis:

• Your baby always looks to the same side
• Their head is often tilted in their car seat
• They always use the same hand to reach for their toys
• They don't like being on their tummy
• They have difficulty turning their head to one side

If you notice these signs, seek advice promptly. The sooner you act, the more effective the treatment will be.

When should you see a physical therapist?

Consult as soon as you notice signs of plagiocephaly. The optimal intervention period is between 1 and 4 months of age. The earlier the intervention, the faster and more effective it will be.

Why is this window so important? Your baby's skull grows very quickly during the first few months. This rapid growth allows the skull to reshape easily with the right interventions. After 4 months, the skull becomes less malleable, and treatment takes longer.

You do not need a prescription from your doctor or nurse to consult with a physiotherapist. You can book an appointment directly with our pediatric physiotherapists.

Your doctor might recommend imaging in some cases to rule out craniosynostosis (premature fusion of the skull sutures). However, imaging is not necessary in the vast majority of cases. A clinical evaluation is usually sufficient.

What does physiotherapy treatment involve?

The physiotherapist assesses positioning habits, the presence of torticollis, and its impact on development. They then teach play positions that promote development and provide specific neck exercises.

At Physioactif, our pediatric physiotherapists understand that parents may feel worried about these exercises. We take the time to practice with you in the clinic. Our goal is for you to feel confident and comfortable applying the recommendations at home.

Treatment duration varies depending on severity. Most families see improvement within a few weeks to a few months.

What exercises can you do at home?

Place your baby on their tummy often for a total of 30 to 60 minutes per day. Attract their gaze to the non-preferred side and frequently vary their positions during waking periods.

A simple tip: change the position of your baby's crib relative to the door or light. Babies tend to turn their heads towards sources of stimulation. By varying these sources, you encourage head rotation on both sides.

If you find it difficult to apply these tips or if your baby really dislikes tummy time, our pediatric physiotherapists can show you tricks to make tummy time more enjoyable.

What accessories are recommended?

Pillows and accessories do not replace tummy time and changes in posture. A butterfly pillow can help before 4 months, while a helmet is reserved for severe cases after 6 months.

Important: all pillows and rolls should be avoided in your baby's crib during sleep. This recommendation aims to prevent Sudden Infant Death Syndrome.

Cranial helmets are reserved for children 6 months and older with severe plagiocephaly that does not respond to repositioning. They are worn approximately 23 hours a day for 2 to 6 months. This option requires a physiatry referral from the doctor who monitors your child.

Accessories never replace active repositioning and tummy time. They are complementary tools, not solutions in themselves.

What is the prognosis?

In the vast majority of cases, the head regains its normal shape before the age of 2. Early intervention accelerates correction and prevents more pronounced deformities.

Here's what you can expect:

• With early intervention (1-4 months): rapid improvement within a few weeks to a few months
• Without intervention but with repositioning: gradual improvement up to 2 years of age
• Mild residual asymmetries: often hidden by hair growth

The most important thing to remember: plagiocephaly does not affect your child's cognitive development. The impact is primarily aesthetic. With the right interventions, the vast majority of babies show excellent improvement.

If you are concerned about the shape of your baby's head, consult our pediatric physiotherapists. We are here to assess the situation, reassure you if everything is fine, and support you if intervention is necessary.