By Dr Timothy Hewitt

The cause and treatment for three common conditions that cause abnormal head shapes in babies; plagiocephaly, torticollis and craniosynostosis.


What is plagiocephaly?

Plagiocephaly (or flat head syndrome) is a common presentation in paediatric plastic surgery practices. Usually the baby’s parents, doctor or child nurse notices the abnormal head shape and refer the baby for investigation and treatment.

There is often parental concern that the baby will have a worsening deformity and that there will be problems with neurological development.

Patients need to be assessed to determine the cause of the headshape and to exclude conditions that may worsen and require surgery.

What causes plagiocephaly?

Deformational plagiocephaly is the most common cause of an abnormal head shape in babies.

This is a flattening of the skull because of pressure on the affected area due to the child lying in the same position. In keeping with SIDS recommendations children are wrapped loosely and positioned on their back to sleep.

As a result of this children can develop a flattening of the back of the skull and can then favour lying on this flat area and thereby exacerbating the problem.

In severe cases the ear and forehead on the affected side can be pushed foreward.

The condition does not cause any problems with brain growth or development.

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Treatment for plagiocephaly

Treatment is by avoiding pressure on the affected area. Techniques such as turning the child’s cot, encouraging ‘tummy time’ during the day, positioning during daytime sleeps and careful use of wedges can be used.

At Princess Margaret Hospital helmet therapy is not used as review of our results with this treatment did not confirm any benefit. No tests are required, the diagnosis is by clinical examination.


What is torticollis?

Torticollis (or wry neck), a tighteness of the strenomastoid muscle of the neck, may cause difficulty turning the head towards the affected side. The inability to turn the head freely will then cause flattening and with time facial asymmetry.

Treatment for torticollis

Treatment of this condition is with physiotherapy and in severe cases surgical release of the muscle.


What is craniosynostosis?

Craniosynostosis is a condition whereby a normal space between the skull bones (suture) fuses prematurely. This results in growth restriction in a particular dimension of the skull and compensatory expansion in other dimensions. An abnormal head shape results.

Craniosynostosis may be associated with problems with brain development. The baby is assessed and if there is suspicion of craniosynostosis a CT scan is performed.

Treatment for craniosynostosis

The treatment of craniosynostosis is surgery to remodel the skull deformity. This is usually performed at 9 months of age.

Next steps

If there are concerns regarding a baby’s head shape a referral should be made to a craniofacial plastic surgeon for specialist review.



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This article is for informational purposes only and should not be taken as medical advice. If in doubt, HealthEngine recommends consulting with a registered health practitioner.

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