• Sierra Christensen

Cranial Conundrums (yes, that's a fancy way of saying head problems...)

#plagiocephaly #pediatrics #awareness #earlyintervention #prevention #headshape #pediatricphysicaltherapy

The second blog in this series is on plagiocephaly, which is very closely related to the first one on torticollis. This is in hopes of empowering YOU, the parents and caregivers. My mission in starting develoPT was to get access to high-quality healthcare and education for ALL children and families. I want to bring more attention to these conditions and possibly help some of you prevent issues with your little one down the road.

If you missed the torticollis guide, you can find that here. Now, on to plagiocephaly (often times called flat-head syndrome).


Plagiocephaly is a condition in which specific areas of a baby’s head develop an abnormal shape and appearance.


-Flattening throughout the back of the head (brachycephaly)

-Flattening on one side of the back of the head

-Ear forward on the same side of the head

-Head tilted to one side

-Bulging forehead on the same side of the head

-Facial asymmetries and abnormalities including uneven forehead, eyes, ears, and/or jaw


There are two different types of plagiocephaly:

-Positional (Deformational) Plagiocephaly (most common)

Caused by pressure on the baby’s skull before or after birth

Usually due to positioning in the first few months of life

Also called ‘flat-head syndrome’

-Craniosynostosis (1 out of 2,200 live births)

Caused by the premature closing of sutures between the skull bones

Requires surgery

Children with plagiocephaly often are referred to a specialist to ensure they do not have craniosynostosis. Craniosynostosis is a much more serious condition that can lead to serious medical emergencies. This will be the focus of the next blog, as there is a very separate list of symptoms and treatment for craniosynostosis. As for this post, I will be referring to positional plagiocephaly.


-Medical conditions


-Developmental delays


-Multiple pregnancy (twins, etc.)

-Abnormal maternal uterine shape/composition

-Frequent time spent lying on back (other than sleep)

-First-born child


-Assisted births (forceps, extraction, etc.)

The main cause of positional plagiocephaly is sleeping on the back, BUT that is the safest position for baby to sleep in. That being said, when baby is awake, they need to spend time in positions that don’t place pressure on the back/sides of their heads. With the right help and guidance from a pediatric PT, you can treat flat spots! Your PT will give you a home program that is specially tailored to your baby. It will give you ideas on how to set up your home, and the CONFIDENCE to apply positioning and strengthening within your little one’s play.


  1. ***FIND a specialist (pediatric physical therapist) that treats this condition frequently.

  2. Make sure that a doctor or specialist clears your baby for craniosynostosis and torticollis.

  3. Limit time in ‘containers’ like carseats, swings, bouncers, Bumbo seats, elevated slings, etc.

  4. They cause poor positioning, pressure on the back of the head (think flat spots), decrease active movement, and make breathing difficult because their chins are resting on their chests.

  5. DO lots of floor time and tummy time to promote exploration and rolling :)

  6. TUMMY TIME!!! SOOO important for little ones’ development, and to strengthen neck and back muscles.

  7. Place baby on back to sleep to decrease SIDS risk, but try to keep the time baby is on back while awake to a minimum.

  8. Change direction of baby’s placement in crib (it helps if you put head towards left on odd days, head towards right on even days, etc.)

  9. Change sides while breastfeeding, bottle feeding, holding, and carrying baby

  10. If addressed early enough with dedicated parents, healthcare providers, and baby, plagiocephaly can be completely resolved!


-Plagiocephaly (flattening on the back of the head) is a common, but easily treatable condition

-Positioning programs can prevent plagiocephaly/keep it from worsening


-Pediatric physical therapy to address muscle development and symmetry

-In most cases, plagiocephaly will not affect brain development

-As your baby grows, often plagiocephaly will improve on its own due to their ability to move and reposition their heads

-If left unaddressed, plagiocephaly can cause issues in the future related to chewing, eating, facial symmetry, vision, and development of skills

***If your baby has a severe case, started treatment late, or is not improving with positioning and therapy, a cranial orthosis (helmet) may be recommended to help mold your baby’s head growth. PLEASE do your research beforehand and speak to a physician specializing in plagiocephaly before purchasing a cranial orthosis.

Knowledge empowers YOU to help your baby embrace their fullest potential! If you would like a helping hand to guide you along the way, and get a customized evaluation for your sweet babe, please reach out to me on my website,

In the meantime, I have put together a visual that summarizes the most important aspects of positional plagiocephaly and treatment. It is awesome to quickly refer to, even with a crying baby ;) You can access it HERE!

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