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To understand why a plagiocephaly occurs in an infant, it is important to know the following: A newborn’s head is made up of seven (7) different bones that are joined together. The area where they join is called a suture. The sutures are important because they give two important prospects to the head: 

i. The head becomessoft and malleable. Thus,it can pass through the vagina during delivery.

ii. The sutures provide space for the baby’s brain to develop.

What is a plagiocephaly?

Plagiocephaly refers to the flat head. The baby’s/infant’s head has an asymmetry. This can happen because the baby’s head is soft and malleable. There is a flattened area in the lateral back of the head. Parents will easily realize that a baby has a strangely shaped head. Usually, the back side of the head is flattened. The ear on this side is pushed forward. 

The diagnosis is made by the doctor who will examine the child once they get detailed history concerning the pregnancy, childbirth and the first months of life. Sometimes they may request additional tests, such as x-rays, CT scans or MRI scans. 

What are the causes and symptoms of plagiocephaly?


The most common cause of plagiocephaly is a baby's sleeping position.

The flat head in this case is due to the prolonged contact / pressure of a specific area on the head. This happens when the baby lies down or sleeps for several hours in a certain position. The area of the head which receives pressure, it becomes flat due to the flexibility of the head.


Torticollis. In torticollis, the baby’s head tilts on one side. In newborns, torticollis can happen due to the baby's position in the womb or after a difficult childbirth. This is usually due to the muscles of the neck being stiff or short on one side and as a result they force the head to tilt on that side. This is called infant torticollis or congenital muscular torticollis.

Craniosynostosis. Craniosynostosis is a birth defect in which the bones in a baby's skull join together too early. This happens before the baby's brain is fully formed. Sometimes the sutures close prematurely (the bones join together completely and as a result they can’t grow any more). This is called the premature convergence of one or more cranial sutures. It can be an isolated condition or associated with congenital syndromes.

How is plagiocephaly treated or prevented?

The treatment of plagiocephaly is directly related to the cause. If plagiocephaly is caused by torticollis, then physiotherapy will improve it and soon it will solve the issue of plagiocephaly. 

If plagiocephaly is the result of craniosynostosis then craniosynostosis must be treated first surgically. In most cases, however, plagiocephaly is due to the position of the head. That is why it is called positional flat head (plagiocephaly). 

Tips for parents

The vast majority of infants with positional flat head do well with simple methods. Here are some tips for parents: 

When putting your baby to sleep, try to place their head on the opposite side than the one they are used to.

Consider changing the position of the bed in the room. There may be something in the room that catches the child's attention and they might want to stare at it.

While the baby is awake you can put them on their belly. Be careful to supervise your baby at all times. In this position you help the baby to develop a beautiful head but at the same time they have the opportunity to explore the environment.

Beware of the various pillows that are sold for the treatment of plagiocephaly. The American Academy of Pediatrics does not recommend any pillow that restricts head movements. You can buy/use them only if they have been prescribed by a specialist.  

The prognosis of children with flat head is excellent. Usually, the problem is solved without any treatment by their first birthday. 

Authored by Dr. Adamos Hadjipanayi, Paediatrician