Neurosurgery - Patient Care and Treatment

Learn about plagiocephaly (OP) and other craniofacial disorders and treatments from the Pediatric Neurosurgery team at Penn State Children’s Hospital.

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Plagiocephaly and other craniofacial disorders

One of the most common reasons for a malformed head shape is occipital flattening (or plagiocephaly, also called OP).

  • OP is often confused with lambdoid craniosynostosis (fusion of the lambdoid suture in the back of the head).
  • In OP, the infant's head is flattened in the back (the occiput) because the infant lies persistently on the back of the head (often with the head turned to one side).
  • The ear on that side is often pushed forward and the forehead may seem a bit larger on that side. The head may have a parallelogram shape.
  • X-rays can show a small amount of bone build-up, which can be misinterpreted as fusion of the lambdoid suture.
  • Occipital plagiocephaly is not caused by lambdoid craniosynostosis and usually does not need to be treated surgically.

It’s important to remember that OP is a cosmetic problem. The brain continues to grow normally. Your child will not have any disabilities from this condition. If treatment starts early, usually before age six months, the results will be very good, with satisfactory head shape by four to five years of age.

If your child has OP, he or she should be examined to rule out craniosynostosis. That is a rare but serious condition where the skull bones fuse improperly and usually must be corrected with surgery.

  • Children with OP may have a parallelogram shape to the head with occipital flattening on one side (right side in 80%), ear displacement and/or prominent forehead on the same side.
  • Children with craniosynostosis usually have a trapezoidal head shape with flattened forehead AND occiput on the same side.
  • If the diagnosis is uncertain, skull X-rays or a CT scan can give more information, although it’s not always needed.

About 10-15% of children with OP also have congenital (present at birth) torticollis. The infant has trouble turning away from the flattened side due to tight or scarred neck muscles. Physical therapy exercises help stretch the neck muscles.

Evaluating plagiocephaly

Most often, doctors can diagnose positional plagiocephaly just by examining the child's head, without lab tests or X-rays. Doctors will also note whether regular repositioning of the child's head during sleep - the most common treatment - successfully reshapes the child's growing skull over time. Craniosynostosis typically gets worse over time.

If there is still some doubt, X-rays or CT scans will show the doctor if the skull sutures are open or fused. If they are open, the doctor will probably confirm the positional plagiocephaly diagnosis and rule out craniosynostosis.

Plagiocephaly treatment

Treating a flattened head, if caused by sleeping position, is usually simple and painless.

Change positions

Your child's doctor will likely recommend:

  • Alternating your child's direction in the crib (one night with his head toward the top of the crib, one night toward the bottom)
  • Alternating his head position during sleep (one night with the left side of his head touching the mattress, one night with the right).
  • Moving your baby's crib to a different area of the room. If there’s a window or toy catching her attention, it may cause her to hold her head in a similar position day after day. Moving the crib will force her to look at it from another position.

Even though your child will probably move his or her head around during the night, it still helps to alternate sides.

Wedge pillows

Wedge pillows are designed to help keep babies lying on one side or the other, but be sure to check with your doctor before using one to make sure it’s appropriate and safe for your baby. The American Academy of Pediatrics (AAP) does not recommend using any devices that may restrict an infant's head movement.

Tummy time

Always be sure your baby gets plenty of time on his stomach during the day, especially while he is awake and you are nearby. Not only does "tummy time" give the back of your baby's head a rest, it also helps in other ways:

  • Looking around from a new perspective encourages your baby's learning and discovery of the world.
  • Being on his stomach helps him learn to push up on his arms, which develops the muscles needed for crawling and sitting up.
  • It also helps strengthen his neck muscles.

Physical therapy for torticollis

If torticollis is the cause of your baby's flattened head, physical therapy and a home exercise program will usually do the trick. A physical therapist can teach you exercises to do with your child at home. Most moves will consist of stretching your child's neck to the side opposite of the tilt. Eventually, the neck muscles will be elongated and the neck will straighten itself out. Rarely, surgery is needed to correct the problem.

Custom molding helmets and head bands

For kids with severe positional OP, doctors may prescribe a custom molding helmet or head band.

  • These work best if started between the ages of four and six months, when your child grows the fastest. They’re usually less helpful after ten months of age.
  • Molding helmets and head bands applying gentle but constant pressure on a baby's growing skull to help redirect growth.
  • Molding helmets are worn for 23 hours each day, usually for three to six months, to gently mold the skull's shape back to normal.
  • Always have a doctor examine your child. Don’t buy or use any helmets or head bands on your own.

Although helmets may not help all children, some children with severe torticollis may benefit from their use.