Flat Skull (Positional Plagiocephaly)

An extremely common condition during an infant’s first year of life, positional plagiocephaly (aka: flattening of a portion of the skull or positional skull deformity), is seen in up to 48% of infants.  This condition which can be alarming at times to parents often resolves without any intervention other than positional changes. Premature babies have an increased incidence of skull deformities.

Even newborns with a normal appearing skull can develop flattening of a portion, typically the back, of the skull.  This is most attributed to excessive time being placed on their backs with the same head position.

Back to Sleep

  • Infants should always be placed on their backs to sleep.  This change recommended by the American Academy of Pediatrics in 1992, has significantly reduced the incidence of sudden infant death syndrome (SIDs) in the past 20 years.

How can I prevent this from happening?

While awake, infants should have between 30-60 minutes of “tummy time” per day.  Along with helping to strengthen the shoulder and back muscles, tummy time also helps to take pressure off of any flat spots which may be present. Prolonged periods of time in swings or car seats (when not in the car) should also be avoided. Additionally, at night or during naps, infants should have their head position alternated (either to the left or right) which will place weight on different areas of the skull. If your infant already has a flattened portion on the back of their skull, position their head on the opposite side during sleep.

My baby was diagnosed with positional plagiocephaly, will they get better?

The majority of infants with a flattened of a portion of the skull (positional plagiocephaly) will improve only with positional changes while asleep and increased amounts of tummy time while awake.  Additionally, some children may require fitting with a helmet which helps to mold the skull into a normal shape.  In rare instances, severe skull deformities may require surgical intervention to help reshape the skull.

The majority of infants with a positional skull deformity do not require x-rays or other radiologic examinations. On average, it takes about 2 to 3 months in order to see marked improvement in the level of deformity once corrective measures have been started.

According to the 2011 article by the American Academy of Pediatrics, there is currently no evidence that molding helmets are better than changes in sleep positioning for mild to moderate skull deformities. Most non-surgical intervention needs to be done prior to 1 year of age as an infant skull is less able to be shaped after 1 year. Infants with more severe deformities typically will be referred to a pediatric neurosurgeon by age 4-6 months or if other treatments fail.

Will my child’s positional skull deformity cause them to have trouble learning in school?

A 2012 study in Pediatrics found that some children with plagiocephaly scored lower on a developmental screen at age 3 years compared to children without plagiocephaly. It is important to recognize that positional plagiocephaly does NOT cause developmental problems in children.  However, the authors of this study encourage pediatricians to screen children with positional plagiocephaly for developmental concerns early so that interventions & treatment can be started if required.

For more information on positional skull deformities or other questions about how to properly position your infant during sleep, please consult with your pediatrician.

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