What is Plagiocephaly?

It is a flattening on one side of the back of the infant's skull, associated with a bulging of the forehead and face on the same side.

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What are the causes of plagiocephaly?

Plagiocephaly is a common condition that affects nearly 20% of newborns.

Rarely present at birth, it usually appears between the 1st and 4th month of the child's life.

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"In the vast majority of cases, the head returns to its normal shape before the age of 2 years."

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‍Plagiocephaly does not limit the development of the child's brain, but it can affect the aesthetic appearance of the baby's skull and face if it is pronounced.

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The main factors that can influence the appearance of plagiocephaly:

• Positional (the majority of cases): associated with a lack of varied positioning of the child while awake. For example, prolonged postures on the back or an environment that favors being awake on one side more than the other (e.g., positioning of the child's room).
• Difficult/premature birth: If the child's stay in the hospital was prolonged at birth and they remained on their back in the same position for a long time.
• Presence of congenital torticollis: Plagiocephaly is very often associated with congenital torticollis. These two conditions should be treated at the same time.

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How to recognize plagiocephaly?

By observing your infant. Place them in a seated position on your legs and observe their skull from above.

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If you observe:

• A flattening on one side of the back of their head
• One ear being further forward than the other
• One side of the forehead being more prominent
• An asymmetry when observing their face

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These are signs of plagiocephaly.

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Any frequent asymmetrical posture of the neck can often also lead to plagiocephaly.

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For example:

• always looks to the same side
• often has their head tilted in their car seat
• always has their head tilted
• seems to have a flat spot on the back of their head
• always uses the same hand to reach for toys or their mouth
• doesn’t like being on their stomach

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‍How is plagiocephaly diagnosed?

The diagnosis is made by taking the child's birth history, observing their skull from several angles, and through palpation.

Your doctor may recommend imaging in certain cases to screen for craniosynostosis (premature closure of the skull sutures), but it is not necessary in the vast majority of cases.

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When should you consult a physiotherapist for plagiocephaly?

You should consult a physiotherapist as soon as you observe the signs described above. The SOONER your child is treated, the quicker and more effective the intervention will be. The optimal intervention period is between 1 and 4 months of age.

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A referral from a doctor or nurse is not necessary to consult a physiotherapist.

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What are the physiotherapy treatments for plagiocephaly?

Your physiotherapist will perform an assessment to determine:

• The lifestyle and positioning habits that may have contributed to the plagiocephaly
• Whether or not there is associated torticollis or any other condition
• The impacts of plagiocephaly on the child's development.

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Based on the assessment results, your physiotherapist will:

• Will teach you how to place your baby on their stomach and in other play positions that promote their development.
• Will give you advice on positioning, breastfeeding, and other lifestyle habits that promote the resolution of plagiocephaly.
• We will provide you with specific exercises to strengthen and improve the mobility of your neck.

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What can you do at home for plagiocephaly?

• Get your child's attention by positioning yourself on their less favored side and placing all sources of stimulation on that side.
• Encourage positions where their head is not resting on a surface (baby carrier, Bumbo seat, tummy time).
• Frequently place them on their stomach, for short periods if needed, for a total of 30-60 minutes per day.
• Frequently vary how you hold or position your child during waking hours.

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Regarding accessories for plagiocephaly:

• All cushions and rolls should be avoided at all times in the baby's bed when they are sleeping.
• They do not replace tummy time and changing the child's positions.
• Heart-shaped pillow: Little demonstrated effectiveness, more useful before 2 months.
• Butterfly pillow: For children under 4 months, it promotes good postural alignment.
• Helmet: For children 6 months and older, it helps accelerate skull reshaping and correct severe deformities. Requires a referral to physiatry by the doctor who is following your child.

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If you find it difficult to apply these tips, our pediatric physiotherapists are here to help. We practice the exercises and positions with you so that you feel confident and comfortable applying them with your child.