Plagiocephaly and Osteopathy
Understanding Plagiocephaly: Causes, Prevention, and Treatment
Plagiocephaly, commonly known as flat head syndrome, is a condition where a baby’s head develops a flattened shape due to prolonged external pressure on one side. As awareness of this condition increases, many parents are looking for effective ways to prevent and treat it. In this blog, we will explore the causes, risk factors, prevention strategies, and how osteopathy can support babies with plagiocephaly.
Types of Skull Shape Abnormalities
Plagiocephaly is one of several positional skull shape abnormalities that can affect infants. The three most common types include:
Plagiocephaly: Characterised by asymmetrical flattening on one side of the head, leading to an uneven skull shape, ear misalignment and in some cases facial asymmetry.
Brachycephaly: This occurs when the back of the head is flattened symmetrically, causing the head to appear wider than normal. It is often associated with babies who spend excessive time lying on their backs.
Scaphocephaly: Also known as dolichocephaly, this condition results in a long and narrow head shape due to excessive pressure on the sides of the skull. It is commonly seen in premature babies who spend extended time in the neonatal intensive care unit (NICU).
What Is Plagiocephaly?
Plagiocephaly refers to an asymmetrical flattening of the skull, typically occurring in infants due to the softness of their bones. It is often noticeable as a flat spot on one side of the head, which may also result in a slight misalignment of the ears or forehead. The condition is usually cosmetic and does not typically affect brain development. However there are associations with breastfeeding issues, digestive issues, torticollis and scoliosis (Kim et al 2019) if left unaddressed.
Types of Plagiocephaly
Plagiocephaly is classified into two main types:
Positional (Deformational) Plagiocephaly: This occurs when a baby’s head is subjected to prolonged external pressure. It is the most common form and can often be corrected with early intervention.
Craniosynostosis: This is a rare but more serious condition where the sutures (soft joints between the bones of the skull) close too early, requiring medical intervention.
Causes and Risk Factors
The most common cause of plagiocephaly is prolonged pressure on one area of the skull. This can happen due to:
Limited neck mobility (Baby torticollis): Some babies have a preference for turning their head to one side due to muscular tightness in the neck (congenital muscular torticollis), increasing pressure on one part of the skull.
Multiple births: In twins or multiple births, space is limited in the womb, which may result in head flattening before birth.
Premature birth: Premature babies often have softer skulls and spend longer periods lying down in neonatal units, making them more susceptible.
First-born babies: A tighter uterus and birth canal in first pregnancies may cause slight head moulding.
Sleeping position: Since babies spend a significant amount of time lying on their backs, especially in the first few months, pressure is exerted on one part of the skull.
Time spent in car seats, prams, or swings: Extended periods in these positions can lead to persistent pressure on the back or side of the head.
Recognising the Signs of Plagiocephaly
Parents should monitor for signs such as:
A visible flat spot on one side of the head.
The baby favouring turning their head in one direction.
Uneven ear positioning when looking at the baby’s head from above.
A slight bulging on one side of the forehead.
Early recognition is key, as treatment is most effective in the first 6 months while the skull is still highly mouldable.
How to Prevent Plagiocephaly
Prevention starts early with simple repositioning strategies and encouraging varied movements. Here are some effective methods:
1. Encourage Tummy Time
Tummy time is one of the best ways to prevent flat head syndrome. It helps babies strengthen their neck muscles and relieve pressure on the back of the head. Start with short sessions of tummy time multiple times a day. Gradually increase the duration as the baby grows. Engage your baby with toys or interaction to make tummy time enjoyable.
2. Vary Sleeping Positions
Gently turn your baby’s head to the opposite side when sleeping. Position their crib or cot to encourage them to look in different directions.
3. Minimise Time in Car Seats and Swings
Avoid excessive time in car seats, prams, and swings where the head remains in the same position. Use a baby carrier to allow more movement and reduce pressure on the skull.
4. Adjust Feeding Positions
If bottle-feeding, switch arms regularly so the baby turns their head to different sides. If breastfeeding, vary positions to encourage head movement.
How Osteopathy Can Help with Plagiocephaly
It offers a gentle, hands-on approach to help address plagiocephaly, particularly in cases where muscle tightness or restricted movement is contributing to the condition.
What Does Osteopathy for Plagiocephaly Involve?
Paediatric Osteopathy: Is a gentle, hands-on technique that can help relieve tension and can encourage normal skull shaping (Panza et al 2024).
Neck Mobility Improvement: If torticollis is present, osteopathy can help release muscular tightness in the neck, allowing more balanced movement.
Postural Advice: Osteopaths provide personalised advice on sleeping positions, tummy time and carrying techniques to optimise skull development.
Parental Guidance: Parents receive guidance on at-home exercises and repositioning strategies to continue progress between sessions.
Osteopathy is non-invasive, painless and safe for newborns, making it an excellent complementary approach to supporting healthy skull development.
When to Seek Professional Help
While mild cases of plagiocephaly often improve with repositioning techniques and tummy time, some cases may require professional intervention. Parents should consider seeking help as soon as possible if your baby has difficulty turning their head in both directions. If your baby has facial asymmetry or ear misalignment. Or if there are concerns about delayed motor development.
Helmets for Plagiocephaly: Are They Necessary?
In some moderate to severe cases, cranial moulding helmets may be recommended. These helmets work by gradually reshaping the skull over time. However, research suggests that repositioning techniques and osteopathy are often enough for mild to moderate cases. Helmets are typically used in more severe cases where other methods have not been effective by 6 months of age.
Plagiocephaly and Osteopathy Conclusion
Plagiocephaly is a common and manageable condition, and early intervention plays a key role in improving head shape and preventing complications. Through tummy time, repositioning techniques and osteopathy, many babies achieve normal skull development without invasive treatments.
If you’re concerned about your baby’s head shape or neck movement, consider booking an osteopathic assessment. Our clinic specialises in gentle, holistic care for babies, supporting healthy growth and development.
References
Panza et al (2024) Positional plagiocephaly: results of the osteopathic treatment of 424 infants. An observational retrospective cohort study Italian Journal of Pediatrics Sep 7;50(1):166. Available at: https://pubmed.ncbi.nlm.nih.gov/39243064/
Kim, J-H. Yum, T-H. Shim, J S. (2019) Secondary Cervicothoracic Scoliosis in Congenital Muscular Torticollis Clinical Orthopaedic Surgery Aug 12;11(3):344–351 Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6695322/
Matthew is a specialist in paediatric osteopath who is passionate about supporting babies with plagiocephaly. He has studied at the prestigious Osteopathic Centre for Children.