Our craniofacial team are experts at diagnosing and treating plagiocephaly. This common condition leads to flattened areas of an infant’s skull. For many babies, treatment may be as simple as adjusting their sleeping and resting position.

At OHSU Doernbecher Children’s Hospital:

• We examine more infants for plagiocephaly than for any other craniofacial condition.
• We are experts at seeing the differences between plagiocephaly and craniosynostosis.
• After diagnosis, we will guide you through simple steps to reshape your infant’s head in the first months of life.
• If your baby needs a helmet to adjust their head shape, we will help you set up a plan and manage treatment at home.

What causes plagiocephaly?

Many children are born with heads that are slightly uneven, and parents and providers may not notice an unusual head shape early on. Because the skull bones are still forming in infancy, head shape often corrects itself within the first 6 weeks of life.

Plagiocephaly that needs treatment has been more common since the 1990s. This is when providers started to tell parents to put babies to sleep on their backs. Back-sleeping lowers the risk of Sudden Infant Death Syndrome (SIDS), but it increases the risk of positional plagiocephaly.

Plagiocephaly develops before or after birth due to repeated pressure on one area of the skull. A baby’s head is soft and can flatten if it is in the same position for long periods of time.

Common causes include:

• Resting position: Plagiocephaly is most common in babies who spend long periods without changing positions in a crib, car seat or baby carrier.
• Certain health conditions: Some infants may stay in one position if their physical development is delayed or if tight neck muscles limit their range of motion.
• Premature birth: A baby born early has a softer skull that is more likely to have an unusual shape. Premature babies also move their heads less often, or they may be in a respirator where they have limited movement.
• Tight space during pregnancy or delivery: A pregnant parent with a small pelvis is more likely to have a baby with plagiocephaly. The condition is also more common for:
  • Infants with large heads
  • Twins or multiple births
  • Firstborn children
  • Infants born in a breech position

Symptoms of plagiocephaly

Common symptoms of plagiocephaly include: 

• Head tilted to one side
• Flat area on one side or on the back of the head
• An ear pushed forward on the same side of the head as the flat spot
• A bulging forehead on the same side of the head as the flat spot
• Uneven cheekbones, eye sockets, or lower jaw

Symptoms of plagiocephaly may be confused with signs of more serious conditions. For that reason, many providers refer infants with signs of plagiocephaly to experts for diagnosis. Our plagiocephaly clinic is the only one of its kind in Oregon.

Diagnosing plagiocephaly

When your child is referred to OHSU, our specialists in skull conditions will do a detailed exam. This will include:

• Learning about your family’s health history
• Measuring your baby’s head circumference, width and length
• Looking for developmental delays

In rare cases, we may need an X-ray or CT scan to diagnose plagiocephaly.

Treatment for plagiocephaly

In many babies, the shape of the head will correct itself within two years. Often this happens when your child begins to sit up. Positional or helmet therapy may help.

Additional services for plagiocephaly

We provide complete care for plagiocephaly, including follow-up care with a nurse practitioner and physical therapists who specialize in this condition. If your baby needs ongoing physical therapy, we will help you find a physical therapist close to your home.

If we recommend positional therapy for your child, you can meet with physical therapists to learn and practice techniques. Our physical therapists are always available to answer questions.

If your child needs a helmet, our nurse practitioner and a physical therapist will support you in managing this therapy.

Learn more

• Flat Head Syndrome and Your Baby, Healthychildren.org, American Academy of Pediatrics
• Positional Plagiocephaly, American Association of Neurological Surgeons