Treatment of Plagiocephaly with Positioning

Once deformational plagiocephaly has been diagnosed by a competent physician, mechanical adjustment and exercise should be started. This is particularly true if the infant is less than four months of age or if the deformity is mild. The infant should be positioned so that the rounded portion of the head is placed dependent against the mattress when the child is asleep. This may be accomplished by rolling a small blanket or by foam rubber wedges that are available. The positioning of the crib in the room should be changed so that the child must look away from the flat side of the head to see the caregivers and its room. Likewise a child should be positioned when in a car seat so he cannot rest on the flat side. When the child is awake he should be placed on his tummy on a firm surface so as to develop strength in the upper chest and neck. Most children will respond in various degrees to this type treatment.

If the child is diagnosed as having Torticollis, i.e. a tightening of the muscle of the neck so that the head is held in one position formal exercises should be initiated. These should be done multiple times a day by the parents after they have been taught by the Physical Therapist. These exercises need to be performed for a long period of time as recurrence with this condition is common.

If the deformity of the skull worsens or does not make significant progress after several months of positioning the infant should be evaluated by a Pediatric Neurosurgeon or Pediatric Craniofacial surgeon. This is important to rule out usual causes of cranial asymmetry and particularly to rule out craniosynostosis, which will always require surgery. If a diagnosis of positional plagiocephaly is confirmed a skull molding helmet can be ordered.