Plagiocephaly

Clinicians in the Departments of Neurosurgery and Plastic Surgery at Children’s Hospital Boston are world leaders in diagnosing and treating plagiocephaly in newborns, infants and older children. We strive to educate families about the condition, explaining why it is not typically cause for alarm and outlining the best ways to approach it. Usually, we recommend one or more of the following approaches:

Sleeping and resting position changes
Your child’s clinician can recommend several steps for keeping your baby from increasing pressure on an already flattened area of her head, and making sure she is not spending too much time in one position. Examples may include:

• giving your baby adequate “tummy time”
• alternating her head position while she is sleeping on her back
• ensuring that she spends minimal time on her back while awake 

Exercises
Many infants with plagiocephaly—especially those born with muscular torticollis, an imbalance of the neck muscles—will benefit from prescribed neck exercises, often under the guidance of a pediatric physical therapist. Learn more about physical therapy at Children’s.

The Plagio Cradle
For infants under 3 months old, we prefer using a molding cup known as the Plagio Cradle to address the flattening process. The Plagio Cradle was developed at Children’s, and is the only device proven effective not only in addressing existing flattening, but also in preventing flattening in babies who are at particular risk for plagiocephaly (for example, those born very prematurely or with muscular torticollis). Learn more about the use of the Plagio Cradle.

The Plagio Cradle is placed under a baby’s head whenever he is lying on his back. It supports his neck and creates a hollowed space that gradually reshapes his head, allowing it to grow correctly over time. As the child ages, the NOPCO Brace Shop at Children's can make adjustments to the original molding.

Corrective helmeting
For infants over 3 months old with a moderate degree of flattening, Children’s typically recommends the use of a corrective helmet—this process is called cranial orthosis. The helmet is a lightweight plastic shell with a foam liner. It acts as a brace to redirect the growth of the baby’s skull. 

If measurements taken by a neurosurgical nurse or surgeon indicate that your child may need a helmet, Children's will put you in touch with a company that will create the helmet. We can also give you a list of convenient locations where you can have the helmet made and bring it back for periodic readjustments. 

Corrective helmets have been in use since 1979 and have an established track record of safely and successfully treating plagiocephaly. A helmet does not squeeze or compress the baby’s head; rather, it serves as a passive restraint to growth in areas that are overgrown while allowing uninhibited growth in areas that are flat. Studies have confirmed that this process does not inhibit brain and head growth, but merely redirects the growth to correct the shape of the head. 

• Because the baby’s head is constantly growing, babies usually wear the helmet 21 to 23 hours a day to get the maximal effect.
• Helmets are most effective in younger infants (4 to 8 months old), who are at the age of fastest cranial growth.
• The average treatment period with a helmet is usually 3 to 6 months, depending on the age of the infant and the severity of the condition.
• Careful and frequent monitoring is required. Helmets must be prescribed by a licensed physician with significant craniofacial experience.

It’s also important to note that very few people have perfectly round heads. Only babies who are active when looking around tend to have symmetrical head shapes. Even when treated with a helmet, a child probably won’t have a perfectly round head.)

Coping and support

When your child has plagiocephaly, your family is likely to have many concerns and questions. In addition to the clinical information offered on this page, Children’s has several other resources designed to give your family comfort, support and guidance, including: 

Our Center for Families, which is dedicated to helping families locate the information and resources they need to better understand their child’s particular condition and take part in their care. All patients, families and health professionals are welcome to use the Center’s services at no extra cost. The center is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information. 

Children's International Center is a dedicated resource for patients and families from countries outside the United States. The center can provide assistance with everything from reviewing medical records to setting up appointments and locating lodging. Contact the center by phone at 01-617-355-5209 or via e-mail at international.center@childrens.harvard.edu.

View a comprehensive list of patient and family resources at Children’s. 

Helpful links

Please note that neither Children’s Hospital Boston, the Department of Neurosurgery nor the Department of Plastic Surgery at Children's unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.

• Craniosynostosis and Positional Plagiocephaly Support, Inc.
• My Banded Baby
• Plagiocephaly Awareness and Support Facebook Page
• Plagiocephaly Information Web
• Positional Plagiocephaly Parent's Support
• Positional Plagiocephaly Yahoo! Group
• Support Kids with Plagiocephaly Facebook Page
• The Healthy Little Heads Foundation
• Torticollis Kids