Plagiocephaly

Quincy's story

Quincy Cunningham was 5 months old when his parents first noticed that the back right side of his head was beginning to look flat. Anthony and Lydia took their first-born son to his pediatrician, who indicated that Quincy appeared to have developed deformational plagiocephaly and referred them to Boston Children's Hospital for treatment.

Deformational plagiocephaly—a condition in which a baby's head becomes flat on one side—occurs in about 10 percent of otherwise healthy newborns. The flattening can occur at the front (deformational frontal plagiocephaly, or DFP) or the back (deformational posterior plagiocephaly, or DPP) of the head.

DPP is far more common. It occurs when the back of the head is flat on one side, the ear on that side is more forward, and there is minor flattening of the forehead on the opposite side. A diagnosis of deformational plagiocephaly is usually made through a physical examination, although it sometimes needs to be confirmed by X-rays.

Babies can be born with deformational plagiocephaly as a result of a tightened womb environment caused by multiple births, a small maternal pelvis or a breech position, but more often than not, the condition develops after birth. Several factors can increase a baby's risk, including torticollis (a congenital condition in which one or more of the neck muscles is extremely tight, causing the head to tilt and/or turn in the same direction), premature birth and back sleeping.

Plagiocephaly is typically treated based on age. If the condition is identified early, when the child is age 3 months or younger, Children's clinicians recommend using a head cup—a device placed under the child's head whenever he is lying on his back. "

As a child grows older he becomes more mobile, so the head cup is no longer effective. For children like Quincy, who are already 4 to 5 months old when the plagiocephaly is detected, a molding helmet is recommended. Much like the head cup, the helmet is casted to fit the child's head and is adjusted as he grows. But the helmet is worn nearly 24 hours a day—with the exception of bath time—for a few months.

"Quincy wore his helmet for about two months," says Anthony. "He was a little unsure about it at first, but after a few days, he got used to it and did great." The Cunninghams saw marked improvement in the shape of their son's head during his time wearing the helmet.

"As a child gets older, his head is less malleable, so it becomes less likely to achieve a completely rounded shape," says Children's neurosurgeon Joseph Madsen, MD. "Of course, the goal with any plagiocephaly treatment is not perfection, it's improvement."