Parents are usually the first to notice what they refer to as a “weird head shape” in their baby. The back or one side of the head is flat, and sometimes there is a bulge in the forehead. A trained craniofacial specialist can easily diagnose deformational plagiocephaly with just a physical exam, with no need for CT scan or MRI to confirm a diagnosis.
Deformational plagiocephaly is expected to improve without any treatment over the course of the child’s first year of life. The process of normalization can vary in how long it takes, but in general a parent will see continued improvement over time even without any intervention.
Parents can help the process along with simple behavior modification, by stimulating the child to spend more time on the non-flattened side of the back of the head (for example, by positioning a favorite toy, hanging mobile, or other attraction in a place that encourages the baby to turn his or her head away from the flattened side). Supervised “tummy time” can also help accelerate the process. Babies with muscular torticollis may need physical therapy to help stretch the tight muscles.
Helmet therapy (dynamic orthotic devices) has been growing in popularity for deformational plagiocephaly, but it can be unwieldy and it is not usually necessary except in the most severe cases. Helmets are typically worn for 23 hours a day until the child is a year old, and need to be replaced as the child’s head grows. For most cases, helmets have not been proven to show a better outcome compared with continued observation and behavior modification.
There is no surgery needed for deformational plagiocephaly, nor are any follow-up assessments or doctor visits necessary. Of course, if parents or pediatrician believe that the condition is worsening, the child should be evaluated by a trained specialist in craniofacial abnormalities for further treatment.
The Weill Cornell Brain and Spine team offers a comprehensive plagiocephaly clinic. This clinic, run by our advanced provider team, provides comprehensive evaluation, management, and treatment for children with positional plagiocephaly. To make an appointment, please call 212-746-2363.
Reviewed by: Caitlin Hoffman, M.D.
Last reviewed/last updated: December 2020