Cranial Remolding helmet worn for the treatment of plagiocephaly

What is plagiocephaly?

Plagiocephaly (sometimes called deformational plagiocephaly or positional plagiocephaly) is a common and treatable disorder in infants.

Plagiocephaly develops when an infant’s soft skull becomes flattened in one area due to prolonged pressure on that part of the head. Many babies develop plagiocephaly by sleeping regularly in one position. There are other types of plagiocephaly, some of which are caused by a serious condition called craniosynostosis. In craniosynostosis, the deformity is caused by premature closure of the fibrous joints (“sutures”) between the bones of the infant.

Treatment for plagiocephaly usually includes special exercises, physical therapy, varying sleep position or wearing corrective helmets.

The Congress of Neurological Surgeons has published guidelines for the diagnosis and treatment of plagiocephaly:

What are the symptoms of plagiocephaly?

Plagiocephaly causes a flattened appearance on one side of a baby’s head. Physically, the infant may have one ear that is shifted forward. In more severe cases, the infant may have forehead or cheek protrusion on the flat side of his or her head.

What are the causes of plagiocephaly?

Most babies develop plagiocephaly by sleeping regularly in one position. Studies show that 20 to 25 percent of infants who sleep on their back develop some degree of plagiocephaly. Due to the “Back to Sleep Campaign” to prevent Sudden Infant Death Syndrome (“SIDS”), the number of SIDS cases has decreased; the flip side has been a dramatic increase in the number of infants with positional plagiocephaly.

A small number of infants have positional plagiocephaly at birth. This is more common in multiple or premature births but can also be caused by position in the womb. Newborn infant skulls are very soft and malleable to help ease them through the birth canal, so it is not unusual for newborns to have unusually shaped heads. This condition usually resolves itself within a few weeks, but some infants may develop a preference to turn their head in one direction during sleep. Infants with torticollis have a shortening of the neck muscles on one side of the neck causing the head to tilt in one direction. Due to the torticollis, they can have difficulty turning their heads to another position. This can resolve with stretching exercises.

How is plagiocephaly diagnosed?

Plagiocephaly is usually diagnosed through a physical examination and through obtaining a medical history from the caregiver.

What can you do to reduce the risk of positional plagiocephaly?

  • Provide the infant with plenty of supervised playtime on his or her tummy. This helps to build and strengthen the neck, shoulder, and arm muscles.
  • Change the direction the baby is lying in the crib on a regular basis to ensure he or she is not always resting on the same part of the head. Consider changing the location of the cribs so that the baby must look in different directions.
  • Avoid too much time in car seats, carriers, and bouncers while the baby is awake.
  • When holding, feeding, or carrying an infant, make sure that there is no undue pressure placed on the flat side of the head. Change infant’s head position from side to side during feeding time.
  • If the baby has torticollis, this may require additional exercise movements.

What are the treatment options for plagiocephaly?

If positional therapy does not work, a cranial molding helmet may be recommended. You will be referred to an orthotist for fitting of the helmet. The orthotist may choose to take clinical photographs and a series of measurements with calipers or a scan to assess the shape of the baby’s skull. These pictures and measurements serve as a point of reference throughout the course of treatment. The orthotist will create a duplicate of the baby’s head using a plaster impression or a 3-D scan. The band will be precisely fabricated and customized to the baby’s head to achieve improved symmetry and proportion.

How long will my baby need a helmet for?

The best age for treatment is between 4 and 7 months old when the skull is growing at the fastest rate. Most babies wear a helmet for 3-4 months depending on the degree of flatness. Helmets are typically worn for 23 hours per day.  The helmet will be adjusted every few weeks to allow for maximum correction.

If the baby has torticollis, physical therapy for neck stretching may be recommended.

Where can I get more information on plagiocephaly?

At New Jersey Pediatric Neuroscience Institute, we take care of many patients with plagiocephaly, torticollis and craniosynostosis.

If you have additional questions or would like to make an appointment with one of our experts, please call us at 973-326-9000.

Mom of two Tatiana Sikorskyj graduated from Rutgers University College of Nursing with a Pediatric Nurse Practitioner degree in January 2012. She then joined the team at New Jersey Pediatric Neuroscience Institute and became certified as a Registered Nurse First Assist in 2013 and assists surgeons in the operating room. Tatiana manages the Institute’s clinical team and maintains a high volume of daily patient visits, both inpatient and outpatient.

Tatiana maintains membership in the National Association of Pediatric Nurse Practitioners, American Association of Neurological Surgeons, American Association of Neuroscience Nurses, American Nurses Credentialing Association, New Jersey State Nurses Association, and Sigma Theta Tau Honor Society of Nursing.