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Positional Skull Deformity

(Flat Head Syndrome; Plagiocephaly; Brachycephaly; Scaphocephaly)

Definition

Positional skull deformity is the flattening of an infant’s head. It is due to continued pressure on one spot of the skull. This causes the head to look distorted. It does not cause problems with brain function or growth.

There are three common types:

  • Plagiocephaly—flattening on one side of the back of the head
  • Brachycephaly—equal flattening on both sides of the back of the head
  • Scaphocephaly—equal flattening of both sides of the head (more common in premature infants)

Infant Brain and Skull

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Causes

Infant’s skulls are softer than those of older children. Pressure on a softer skull can change the shape of the head. This can happen when the head rests in the same position for long periods of time. Young infants have little control over head movement. They may spend long periods of time in the position they are placed in.

Risk Factors

Things that raise the risk of positional head deformity in babies are:

  • Sleeping or laying in the same position
  • Head tilting to one side—torticollis
  • Premature birth
  • Weak muscles that prevent the head from turning

Symptoms

Babies with this condition have a flattened spot on one area of the head. Sometimes the face is distorted on the opposite side.

Diagnosis

Diagnosis is made by physical exam and appearance.

Treatment

The goal of treatment is to correct the shape of the baby's head. Options are:

  • Changing the baby's position often—to relieve pressure on the affected part of the skull
  • Physical therapy—to strengthen the baby's neck muscles
  • A helmet—to help reshape the head

Prevention

Positional skull deformity may be reduced by:

  • Changing the baby's head position from left to right at night
  • Letting the baby spend 30 to 60 minutes a day on his or her stomach
  • Limiting the amount of time a baby spends in car seats and swings.
RESOURCES:

Healthy Children—American Academy of Pediatrics
https://www.healthychildren.org

Kids Health—Nemours Foundation
http://kidshealth.org

CANADIAN RESOURCES:

Caring for Kids—Canadian Paediatric Society
https://www.caringforkids.cps.ca

Health Canada
https://www.canada.ca

REFERENCES:

Flat head syndrome (positional plagiocephaly). Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/positional-plagiocephaly.html. Accessed February 11, 2021.

González-Santos J, González-Bernal JJ, et al. Infant cranial deformity: cranial helmet therapy or physiotherapy? Int J Environ Res Public Health. 2020 ;17(7):2612.

Plagiocephaly and brachycephaly (flat head syndrome). NHS Choices website. Available at: https://www.nhs.uk/conditions/plagiocephaly-brachycephaly. Accessed February 11, 2021.

Positional head deformity. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/positional-head-deformity-15. Accessed February 11, 2021.

Positional plagiocephaly. UCSF Benioff Children’s Hospital website. Available at: https://www.childrenshospitaloakland.org/main/Positional-Plagiocephaly.aspx. Accessed February 11, 2021.

Last reviewed January 2021 by EBSCO Medical Review Board Chelsea Skucek, MSN, BS, RNC-NIC  Last Updated: 2/11/2021