One day, while you are bathing them, brushing their hair or gazing down at them as they rest in your arms, the question that worries so many parents comes up: does your baby's head look flatter to you?
In the vast majority of cases, what we are looking at is what we call positional plagiocephaly.
Positional plagiocephaly is an asymmetric deformity or flattening at the back or side of an infant's head, caused by the continued action of external mechanical forces on a skull that is still developing. During the first months of life, a newborn's skull bones are soft and joined by open sutures, to allow the brain to grow rapidly and to ease the passage through the birth canal. For this reason, if the head rests on the same spot for long periods, that area tends to give way and flatten.
The direct cause of the flattening is repeated resting on the same spot, but the key question from a physiotherapy point of view is: why does the baby always rest towards the same side? Among the main factors are:
When plagiocephaly is present, specialised paediatric physiotherapy is the first line of intervention.
During the first months of life (especially between 0 and 5-6 months), a baby's skull grows at its fastest rate and has a high degree of plasticity. What flattens quickly at this stage can also round out soon if we take the pressure off in time. Also, before 5 months the baby cannot yet move around independently, which makes positioning measures and manual therapy maximally effective.
In clinic we do not only address the shape of the head, but the cause behind it. We treat torticollis or neck tension with gentle manual therapy techniques, stretches and mobilisations to give the neck back its full range of movement. We also teach parents motor stimulation exercises and guidelines for encouraging time on their front in a safe and friendly way. The evidence shows that a physiotherapy programme significantly reduces the risk of severe deformity compared with giving generic positioning advice alone.
To follow your baby's progress with the utmost professional rigour, we do not rely on a simple visual impression. In clinic I quantify plagiocephaly using a craniometer (an anthropometric calliper designed for an infant's head).
With this instrument, we measure the cranial diameters and diagonals to calculate objective asymmetry indices (such as the cranial vault asymmetry index, or CVAI). This assessment allows us to:
And tell it apart from other conditions.
Determining whether it is mild, moderate or severe.
Session after session, verifying the effectiveness of the treatment and adjusting our strategies to your baby's exact progress.
Many parents come to the clinic wondering whether their child will need an orthopaedic helmet. The scientific evidence gives us clear guidelines depending on the quantified degree of deformity:
The treatment of choice is 100% conservative: paediatric physiotherapy combined with positioning measures at home. The scientific literature shows that mild deformities respond optimally when neck mobility is freed up and the resting points are redirected. In these cases, a helmet is not indicated and brings no additional benefit.
Physiotherapy remains the first line of action. By intervening early with manual therapy and motor re-education, the asymmetry decreases markedly and most babies manage to correct without needing an orthosis.
A helmet is considered as a second line of treatment, mainly in moderate or severe deformities that have not shown the expected improvement after well-executed conservative treatment up to 5 or 6 months of age, or in cases diagnosed very late.
The helmet acts as an external mould that speeds up the rate of correction in the first months of use in moderate and severe asymmetries. However, systematic reviews and clinical trials indicate that, in the long term (at 12 and 24 months), head-shape outcomes with appropriate conservative treatment and with a helmet tend to even out. In addition, a helmet does not correct torticollis or the underlying neck restriction, so physiotherapy remains essential to treat the primary cause.
Finding an asymmetry in your baby's head can be worrying, but remember that spotting it in time is the first step towards solving it. With the right assessment, measurement in clinic and paediatric physiotherapy support adapted to your child's needs, we can give their neck back its mobility and guide the natural rounding of their little head as they grow.
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