Plagiocephaly and brachycephaly are common conditions that cause abnormal head shapes.
Plagiocephaly describes flattening of one area of the head. Plagio- translates as oblique, or slanted.
Brachycephaly describes flattening at the back of the head, resulting in a short head from back to front with increased width from side to side. Brachy- translates as short.
Positional plagiocephaly occurs when a baby tends to rest their head on a particular area, causing the skull bones to mould under gravity and pressure, creating an abnormal head shape.
Presentation
The typical presentation is a baby aged 3-6 months with an abnormal head shape.
Assessment
Craniosynostosis (premature fusion of the sutures) should be considered based on a thorough history and physical examination, including assessment and palpation of the sutures. Specialist assessment and imaging may be required if there is diagnostic uncertainty.
Congenital muscular torticollis (CMT) must also be considered, which involves sternocleidomastoid muscle shortening on one side. This may be the reason the child tends to rest on one side of their head. Physiotherapy can help with movement exercises to treat torticollis.
Management
An abnormal head shape can cause parental anxiety, requiring an adequate explanation and reassurance. In most cases, the head shape will return to normal as the child grows. In some cases, asymmetry can persist.
Simple measures can be taken to encourage the baby to avoid resting on the flattened area:
- Positioning them on the rounded side for sleep
- Supervising tummy time
- Minimising time in pushchairs and car seats
Plagiocephaly helmets are marketed as a treatment option for plagiocephaly. They need to be used for most of the day, and can lead to skin problems (e.g., contact dermatitis) and psychosocial problems. They are not routinely available on the NHS.
Last updated January 2026
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