Plagiocephaly or flat head

Plagiocephaly is a common condition that worries many parents. Have you noticed that your baby's head seems flattened on one side? Rest assured, this condition can be easily corrected with early intervention. As pediatric physical therapists, we regularly work with families in this situation. Here's what you need to know to take effective action.

What is plagiocephaly in babies?

Plagiocephaly is a flattening of one side of the back of an infant's skull, often accompanied by a bulging 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 months 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 returns to its normal shape before the age of 2. The impact is mainly cosmetic if the condition is pronounced and left untreated.

What causes flat head syndrome?

Plagiocephaly is mainly caused by a lack of variety in positions during periods of wakefulness. It can also be linked to a difficult delivery, 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 have torticollis. These two conditions must be evaluated and treated together to achieve the best results.

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

How to recognize plagiocephaly?

Observe your baby from above while 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 their skull.

Certain behaviors also suggest a positioning problem or associated torticollis:

- Your baby always looks in the same direction - Their head often tilts to one side in their car seat - They always use the same hand to reach for toys - They don't like lying on their stomach - They have difficulty turning their head to one side

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

When should you see a physical therapist?

Consult a specialist as soon as you notice signs of plagiocephaly. The optimal age for intervention is between 1 and 4 months. The earlier the intervention, the quicker 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 be easily reshaped with the right interventions. After 4 months, the skull becomes less malleable and treatment takes longer.

You do not need a referral from your doctor or nurse to see a physical therapist. You can make an appointment directly with our pediatric physical therapists.

Your doctor may recommend imaging in some cases to check for craniosynostosis (premature closure of the skull sutures). Imaging is not necessary in the vast majority of cases. Clinical evaluation is usually sufficient.

How does physical therapy treatment work?

The physical therapist assesses positioning habits, the presence of torticollis, and the impact on development. They then teach play positions that promote development and give specific exercises for the neck.

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

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

What exercises can I do at home?

Place your baby on their stomach often for a total of 30 to 60 minutes per day. Draw their gaze to their non-preferred side and vary their position frequently during periods of wakefulness.

A simple tip: change the position of your baby's bed in relation to the door or the light. Babies tend to turn their heads toward sources of stimulation. By varying these sources, you encourage them to turn their heads to both sides.

If you find it difficult to apply these tips or if your baby really dislikes being on their stomach, our pediatric physical therapists can show you tricks to make the prone position more comfortable.

What accessories are recommended?

Cushions and accessories are not a substitute for the prone position and changes in posture. The butterfly cushion can help before 4 months of age, while the helmet is reserved for severe cases after 6 months.

Important: All pillows and bolsters should be kept out of your baby's bed during sleep. This recommendation is intended to prevent sudden infant death syndrome.

The cranial helmet is reserved for children aged 6 months and older with severe plagiocephaly that does not respond to repositioning. It is worn for approximately 23 hours a day for 2 to 6 months. This option requires a referral to a physiatrist by the doctor who is treating your child.

Accessories are never a substitute for active repositioning and prone positioning. They are complementary tools, not solutions in themselves.

What is the prognosis?

In the vast majority of cases, the head returns to 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 - Slight residual asymmetries: often masked by hair growth

The most important thing to remember is that plagiocephaly does not affect your child's cognitive development. The impact is mainly cosmetic. With the right treatment, the vast majority of babies develop perfectly well.

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.