What is plagiocephaly?

Plagiocephaly, also known as “flat head syndrome,” is the term used for asymmetry or widening of an infants skull.

There are three main types of Positional Plagiocephaly

  • Plagiocephaly-asymmetrical head shape, one side is flatter than the other

  • Brachycephaly-wider head shape with a general flattening of the entire back of the head

  • Scaphocephaly-narrow head shape with flattening along both sides of the head

What causes plagiocephaly?

•Positioning in the womb: Sometime a baby will find a cozy place in the womb and stay there for most of the pregnancy. Their soft skull is not allowed the space it needs to round out.

•Restricted space in the womb: Plagiocephaly is often seen in multiple births due to the limited amount of space in the womb, causing flattening in one or more of the babies.

•Positioning during delivery: If the baby sits in the birthing canal for a long period of time this can lead to Plagiocephaly.

•Increased time on their backs after birth: The “Back to Sleep” campaign started in 1992, reducing the risk for SIDS. But since babies are now sleeping on their backs there is a greater need to increase Tummy Time while they are awake.

•Torticollis: Torticollis is the tightening of one side of the neck, causing a baby to look one way more than the other. If a baby favors looking and sleeping on one side it can lead to plagiocephaly.

•Reflux and developmental delays: Babies that cannot tolerated Tummy Time or are unable to gain neck strength by 2 months of age are more likely to develop a flat spot.

How common is plagiocephlay?

The incidence of plagiocephaly has become more common since the “back to sleep” campaign began in 1994. The back to sleep campaign has been extremely successful in reducing the rate of SIDS (sudden infant death syndrome) but infants are spending more time on the back of their heads, leading to an increase in plagiocephaly. On average plagiocephaly is seen in 46.6% of infants age 7-12 weeks *(Pediatrics 2013 Aug;132(2):298-304. doi: 10.1542/peds.2012-3438. Epub 2013 Jul 8.The incidence of positional plagiocephaly: a cohort study)*


How is it related to toroticollis?

Torticollis is the medical term for tight neck muscles in an infant. Sometimes when a baby has tight neck muscles on one side they have a difficult time looking both directions, which can lead to flattening on one side of their head. If it seems difficult for your baby to look both ways or to tilt the right ear to the right shoulder and the left ear to the left shoulder ask your pediatrician about the possibility of torticollis. If your baby is diagnosed with torticollis, do not be alarmed! Most torticollis is successfully treated with a few weeks of physical therapy and helmet treatment can correct their head-shape!



More about Tummy Time and Repositioning

Tummy Time and regular repositioning can help reduce the occurrence of plagiocephaly. According to the American Association of Pediatricians, it is best to begin tummy time as soon as you bring them home from the hospital for about 3-5 minutes 2-3 times a day. See the AAP website for more information.



When should you schedule an assessment?

Treatment for Positional Plagiocephaly is time sensitive because it relies on the baby’s head growth to make positive changes. If you see a noticeable flattening or asymmetry in your child’s head shape it is best to get an evaluation scan between 3-4 months of age.




When is the best time to start helmet treatment?

The best time to start helmet treatment is between 4-6 months of age when the baby’s head is doing a lot of growing. You can still get correction up to 18 months of age but it will take longer.




How long does helmet treatment last?

The amount of time it takes varies with each situation. The sooner we can start treatment the shorter the amount of time is needed. On average a 4 month old with moderate to severe positional plagiocephaly will need 3-4 months of treatment. A 6 month old with moderate to severe positional plagiocephaly will need 5-6 months of treatment.

What can I expect at the assessment scan?

Tiny Wonders will arrive at your home within 5 minutes of your scheduled appointment time. Please have your baby dressed in a simple outfit with no collar, or puffy/frilly sleeves.

If possible please have a Bumbo type seat available to use for pictures and measurements. But don’t worry if you don’t have one, our specialist are always prepared!

There will be some initial questions about your baby and their birthing history to assess the cause of the plagiocephaly. A light cotton cap will be placed on your baby’s head for a visual assessment of any asymmetry that might be present in their head and face. Pictures and measurements will be taken. Next a special “SmartSoc” will be placed on your baby’s head and a scan will be taken using Orthomerica’s portable scanner.

Your specialist will pull up the scan on their computer and discuss the results.

It is Tiny Wonder’s goal that the assessment appointment is a comfortable experience for both you and your baby. The goal is to gather information regarding your baby’s head shape and potential for self correction. We love giving the good news that your baby does not need a helmet, but if self correction is not possible we will work hard to make your helmet treatment experience a stress free one!

At the end of the evaluation appointment we hope to answer all of your questions and concerns and together we will come up with a plan.

What can I expect at the fitting appointment?

Tiny Wonders will come to your home to fit the helmet 2 weeks after it is ordered. Your baby’s helmet is custom made from their 3D scan, but it will need a little trimming to make sure it doesn’t touch or cover your baby’s eyes and ears. After the helmet is trimmed and fitting perfectly your specialist will review the helmet instructions and wearing schedule with you. You will get a chance to practice taking the helmet off and putting it back on. All of you questions will be answered and a follow-up visit will be scheduled to check on your baby 2 weeks after the fitting appointment.

How often will my baby need an adjustment?

On average babies are seen every 2-3 weeks for helmet adjustments and follow-up scans. This varies based on the baby’s age and severity of their head shape.

Can my baby’s head improve of its own?

Yes, it is possible for a baby’s head to have some self-correction. But it depends on the baby’s age, severity of the plagiocephlay, torticollis involvement, and development. The greatest amount of self correction is usually seen by 4 months of age. It is not as common to see complete correction after 4 months of age and it can take several months for the head to self correct.


How do re-assessment scans work?

If there is potential for self correction we can schedule a comparison scan in 4-6 weeks to evaluate effectiveness of repositioning and Tummy Time efforts at home. We usually don’t recommend comparison scans for babies older than 5 months of age unless their plagiocephaly is very mild. We do not want to waist your time with repositioning efforts if complete self correction can not be achieved in 4-6 weeks.



What helmet do you use?

Tiny Wonders uses Orthomerica’s STARBand for plagiocephaly treatment. We have used this design for over 5 years and had outstanding results! The STARband is an FDA regulated device consisting of a thin plastic outer shell and ½” hypoallergenic foam inner lining. Each helmet is custom made within 2 weeks of ordering. The helmet is designed with the needed correction built in, so there are minimal adjustments needed and usually only ONE helmet is required to reach full correction.  


Decorating your helmet

Helmet life is more fun when you can add your baby’s personality into it! There are over 50 pattern and color options available for the STARband, at no extra charge. You can also decorate your baby’s helmet using stickers and paint.

See our Resource page for more information.

What is the difference between craniosynostosis and plagiocepahly?

Plagiocephaly is asymmetry of the skull caused by positioning and can usually be corrected through re-positioning efforts or helmet treatment. Craniosynostosis is the medical term used for asymmetry of the skull caused by early fusion of the skull bones in an infant (also called sutures). This condition is usually diagnosed very early and can only be corrected with surgery.

For more information on Craniosynostosis