Understanding Positional Plagiocephaly in Infants | Physio Therapist Guide
August 21, 2025
Positional plagiocephaly is becoming more common in infants, characterized by an asymmetrical deformation of the skull. Several factors contribute to this condition, including first births, assisted deliveries, multiple births like twins or triplets, prematurity, congenital muscular torticollis, and prolonged periods where the baby lies in the same position. Two distinct types of plagiocephaly exist: one accompanied by craniosynostosis, a condition where the skull bones fuse prematurely, and positional plagiocephaly without craniosynostosis. The latter is more prevalent and doesn’t impact skull growth but can alter head shape, typically causing flattening on one side of the posterior aspect of the head.
Causes and Risk Factors in Infants
An Infant’s skull is susceptible to deformation due to its composition of bony plates joined by sutures. These sutures enable movement necessary for brain growth and facilitate molding of the head during delivery. External forces exerted on the developing skull, often from lying on firm surfaces like cribs, car seats, or strollers, lead to positional plagiocephaly. Despite the “Back to Sleep” campaign’s recommendation to minimize sudden infant death syndrome risk, this practice can contribute to positional plagiocephaly due to prolonged supine positioning. Congenital muscular torticollis, a neck muscle imbalance, co-occurs with positional plagiocephaly in up to 30% of cases.
Physiotherapy and Treatment Options for Congenital Muscular Torticollis
Diagnosis primarily relies on the child’s medical history and clinical presentation. In some instances, a skull X-ray may be necessary to exclude craniosynostosis. Management through physiotherapy encompasses educating caregivers, positioning strategies to reduce pressure on flattened areas, limiting time spent in containers such as rockers or hammocks, promoting tummy time, and potentially utilizing helmet therapy for severe and persistent cases. Helmet therapy is applicable in less than 10% of babies with significant and ongoing deformity. There’s limited evidence to support helmet use in healthy, typically developing infants.
Effective Management Strategies for Positional Plagiocephaly
Congenital muscular torticollis can lead to plagiocephaly due to neck muscle imbalance. Physiotherapeutic interventions for CMT involve stretching exercises, muscle strengthening, and repositioning techniques. Initiating treatment for CMT before the infant reaches 6 months results in improvement in about 97% of cases. Management strategies for CMT include manual therapy techniques like therapist-led stretching, repositioning therapies such as encouraging tummy time, and in more severe cases that don’t respond to conservative management, interventions like botox injections or surgical options might be considered.
Most infants with positional plagiocephaly show improvement with straightforward adjustments like increased tummy time and varied positioning. Consulting a pediatrician is advisable if concerns about the baby’s head shape arise. Since positional plagiocephaly typically doesn’t self-correct, timely intervention plays a crucial role in managing the condition effectively.
Dr. Abdul Moiz
Physio Therapist
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