Defined simply, plagiocephaly is merely an asymmetry or change to the normal shape of the skull.1 We can see many different types of this, ranging from flattening on one side to just flat at the back, and conditions causing this range from simple positional deformation to the more serious and complex synostosis. But we won’t talk about that one today, let’s focus instead on simple deformational or positional plagiocephaly.
It is quite a common condition, and it is becoming more common since the inception of the “Back to Sleep” program initiated in 1992. In 2004, nearly 20% of infants aged around 4 months had plagiocephaly,2 but this number has increased to over 40% of 3-month olds.3–5
This raises a very important question; how does plagiocephaly occur? Well, we know that a baby’s skull is still quite mobile, and the bones of the skull are still relatively soft. So when we maintain a certain position for an extended period of time, the pressure from gravity on that baby’s head causes a change in the head shape. But then this raises another question; why is there a positional preference occurring?
Positional preferencing is a topic as a chiropractor that I have quite an interest in. What moves our heads? Our neck. And what governs that movement? The combination of joints, muscles, and the control of this from our nervous system. There are a couple of research papers out there looking at the interaction between the spine and the development of plagiocephaly – including one I had published in 2020 – in which we found that over 90% of infants with positional plagiocephaly had evidence of restriction in motion when moving their neck in one direction compared to the other.1,6,7 This can be tricky as a parent to identify, you can’t easily ask your baby to turn from side to side so you can compare. There are a few other ways that we could assess this though: does your baby breastfeed better on one side compared to the other? Do they lay facing one way all the time? This could be because they cannot turn their heads comfortably to one or the other side.
Another interesting component to this has started to gain more traction and understanding in the last few years, the importance of your Vitamin D levels. As a part of a routine blood test during your pregnancy, your Vitamin D levels are assessed. (The “normal” level is typically 75 nmol/L or above, however, this is met with controversy as a level cannot be considered normal when there are conditions that occur at this level!) Why are we getting this tested? Well, aside from many other functions of Vitamin D, one function is to assist in healthy bone development. If you are low in Vitamin D, your bub is likely to be low in Vitamin D as well, and this may impact bone development, making the bone softer and more susceptible to changes in shape from that prolonged positioning.
So how can we identify the beginnings of plagiocephaly? Well, as I was saying earlier, we can often catch it before it begins by watching for particular behaviours. If we do notice that bub faces one way all the time, we can then look at the shape of their head from the top down, and make sure there is a nice, rounded shape present. Are the ears in the same place on either side? Is there a change to the shape of the forehead? These landmarks can help us determine the presence and severity of plagiocephaly.8
But why am I carrying on about plagiocephaly? Isn’t it just a cosmetic issue? Don’t babies just grow out of it?
Well, sometimes yes. As your child gets older, and as their brain grows, there is a chance that it may improve in shape.9 My concern, however, stems from a fascinating research article by Martiniuk in 2017, in which he performed a systematic review (one of the highest levels of research evidence) and found that the presence of plagiocephaly increased your child’s risk of developmental delay by up to 40%, especially in language and gross motor streams.10 This has been furthered upon by other researchers, who have found that infants with plagiocephaly performed worse than their peers academically right up to 9-12 years of age – and they are only up to that age because that’s the age of the kids growing up in the study.11–15
(Why does this happen? That’s a great question – and it will take another whole blog post to touch on the surface of the why! Stay tuned!)
So what can be done? Firstly, we would need to have your child assessed. Child Health Nurses are in an ideal situation to be able to perform this routine screening, and the vast majority of them do so. The difficulty comes when you have a global pandemic hit and you are in a state of lockdown and unable to attend physical appointments. Video calls are convenient but not great at being able to identifying this condition. The next port of call would be your health care professional who has been trained or upskilled in paediatric assessment and management; your general practitioner, osteopath, physiotherapist or chiropractor (among others – sorry if I didn’t include your profession). Identifying plagiocephaly and its severity then allows us to make the best decision regarding treatment. In some cases, this may be simple stretches or mobilisations/manual therapy to your child’s neck, and in other cases, concurrent helmet orthosis may be required as well.
Ultimately, once identified, plagiocephaly can be managed conservatively and with wonderful rates of success, but it does depend on early identification and appropriate management.
Thank you for your time – I hope you enjoyed the read. If you have any questions about this topic, I would be more than happy to discuss them with you.
Chiropractor for Children
For more information, I have created a short YouTube video that details methods in which we can visually identify plagiocephaly: https://youtu.be/KSoQOg3L5v4
And here is an older video (due to be updated shortly) providing a bit more information about this condition: https://youtu.be/YV8o7z9PZBI
- Fludder CJ, Keil BG. Deformational Plagiocephaly and Reduced Cervical Range of Motion: A Pediatric Case Series in a Chiropractic Clinic. Altern Ther Health Med. 2020;(1):3-9.
- Hutchison BL, Hutchison LAD, Thompson JMD, Mitchell EA. Plagiocephaly and brachycephaly in the first two years of life: A prospective cohort study. Pediatrics. 2004;114(4):970-980. doi:10.1542/peds.2003-0668-F
- Mawji A, Vollman AR, Hatfield J, McNeil DA, Sauvé R. The incidence of positional plagiocephaly: A cohort study. Pediatrics. 2013;132(2):298-304. doi:10.1542/peds.2012-3438
- di Rocco F, Ble V, Beuriat PA, Szathmari A, Lohkamp LN, Mottolese C. Prevalence and severity of positional plagiocephaly in children and adolescents. Acta Neurochirurgica. 2019;161(6):1095-1098. doi:10.1007/s00701-019-03924-2
- Ballardini E, Sisti M, Basaglia N, et al. Prevalence and characteristics of positional plagiocephaly in healthy full-term infants at 8–12 weeks of life. European Journal of Pediatrics 2018 177:10. 2018;177(10):1547-1554. doi:10.1007/S00431-018-3212-0
- Murgia M, Venditto T, Paoloni M, et al. Assessing the Cervical Range of Motion in Infants With Positional Plagiocephaly. J Craniofac Surg. 2016;27(4):1060-1064. doi:10.1097/SCS.0000000000002644
- Sergueef N, Nelson KE, Glonek T. Palpatory diagnosis of plagiocephaly. Complement Ther Clin Pract. 2006;12(2):101-110. doi:10.1016/j.ctcp.2005.11.001
- Branch LG, Kesty K, Krebs E, Wright L, Leger S, David LR. Argenta clinical classification of deformational plagiocephaly. J Craniofac Surg. 2015;26(3):606-610. doi:10.1097/SCS.0000000000001511
- Bialocerkowski AE, Vladusic SL, Wei Ng C. Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Developmental Medicine & Child Neurology. 2008;50(8):577-586. doi:10.1111/J.1469-8749.2008.03029.X
- Martiniuk ALC, Vujovich-Dunn C, Park M, Yu W, Lucas BR. Plagiocephaly and Developmental Delay: A Systematic Review. Journal of Developmental and Behavioral Pediatrics. 2017;38(1):67-78. doi:10.1097/DBP.0000000000000376
- Collett BR, Wallace ER, Ola C, Kartin D, Cunningham ML, Speltz ML. Do Infant Motor Skills Mediate the Association Between Positional Plagiocephaly/Brachycephaly and Cognition in School-Aged Children? Physical Therapy. 2021;101(2). doi:10.1093/PTJ/PZAA214
- Collett BR, Wallace ER, Kartin D, Cunningham ML, Speltz ML. Cognitive outcomes and positional plagiocephaly. Pediatrics. 2019;143(2). doi:10.1542/peds.2018-2373
- Fontana SC, Daniels D, Greaves T, Nazir N, Searl J, Andrews BT. Assessment of deformational plagiocephaly severity and neonatal developmental delay. Journal of Craniofacial Surgery. 2016;27(8):1934-1936. doi:10.1097/SCS.0000000000003014
- Hussein MA, Woo T, Yun IS, Park H, Kim YO. Analysis of the correlation between deformational plagiocephaly and neurodevelopmental delay. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2018;71(1):112-117. doi:10.1016/j.bjps.2017.08.015
- Kim DH, Kwon DR. Neurodevelopmental delay according to severity of deformational plagiocephaly in children. Medicine. 2020;99(28):e21194. doi:10.1097/MD.0000000000021194