Plagiocephaly and brachycephaly are very common conditions that cause abnormal head shapes in otherwise normal health babies. Plagio- translates as oblique, or slanted. Plagiocephaly refers to flattening of one area of the baby’s head. Brachy- translates as short. Brachycephaly refers to flattening at the back of the head, resulting in a short head from back to front.
These conditions occur where a baby had a tendency to rest their head on a particular point, resulting in the skull bones and sutures moulding with gravity to create an abnormal head shape. This is called positional plagiocephaly. This has become more common as parents are advised to rest babies on their back to reduce the risk of sudden infant death syndrome.
The typical presentation is a baby aged 3 – 6 months with an abnormal head shape. They often have a history of preferring to sleep on one side of their head.
Exclude craniosynotosis with a thorough history and properly palpating the sutures. Where there is doubt refer for specialist assessment and imaging.
Look for congenital muscular torticollis (CMT), which is a shortening of the sternocleidomastoid muscle on one side. This may be the reason the child always rests on one side of their head. Physiotherapy can help with movement exercises to treat the torticollis.
Reassurance is key. An abnormal head shape can cause a lot of parental anxiety. In the vast majority of cases the head shape will return to normal as the child grows.
Simple measures can be taken to encourage the baby to avoid resting on the flattened area:
- Positioning them on the rounded side for sleep
- Supervised tummy time
- Using rolled towels or other props
- Minimising time in pushchairs and car seats
Plagiocephaly helmets are marketed as a treatment option for plagiocephaly. They have some limitations in that they need to be used for the vast majority 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 2020