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What is Plagiocephaly?

Plagiocephaly is when a flat spot develops on part of the head due to the skull changing shape. In a typical plagiocephaly presentation, there is flattening on one side of the occiput (back of head) and bossing (bulging) on the opposite side of the occiput. A child with moderate or severe plagiocephaly may develop a head shape that resembles a parallelogram. Plagiocephaly occurs due to intrauterine positioning, positional preference during infancy, or secondary to torticollis. If a baby is stuck in one position in the womb for an extended period of time, their skull may form with a flat spot where it was pressed against the uterine wall. Additionally, a child who prefers to always look one direction due to preference or torticollis may also develop a flat spot on the same side of the head as the positional preference or on the side of the head opposite to the torticollis.

What are the Signs of Plagiocephaly?

  • Flattening on one side of occiput

  • Ipsilateral (same side) ear shifted forward or down

  • Ipsilateral bossing of forehead

  • Ipsilateral facial asymmetry including bigger forehead, eye, and eye orbit compared to contralateral (opposite side) face

  • Chin deviation to side of plagiocephaly

  • Difficulty with visual tracking to contralateral side

How is Plagiocephaly Measured?

Plagiocephaly is measured by calculating a child's Cranial Vault Asymmetry Index (CVAI). The CVAI determines the severity of asymmetry between the left and right sides of the head. Two diagonal measurements of the child's head are taken and put into an equation to establish the CVAI. These diagonal measurements are measured from the outer edge of the left eyebrow to the back of the right side of the head, and the outer edge of the right eyebrow to the back of the left side of the head. These measurements are taken with cranial calipers or advanced imaging equipment. A CVAI of < 3.5 indicates head symmetry within normal limits. A CVAI of > 3.5 indicates head asymmetry, with higher numbers indicating higher severity of asymmetry.

How is Plagiocephaly Prevented and Treated?

Plagiocephaly that occurs due to intrauterine positioning cannot be prevented, but plagiocephaly secondary to positional preference or torticollis can be (known as positional plagiocephaly). Positional plagiocephaly often occurs due to babies spending extended periods of time lying on their backs with their head turned one way. Positional plagiocephaly prevention includes repositioning strategies and devices. With the Back To Sleep campaign, babies spend a lot of time on their backs due to the high number of hours they sleep every day. The best repositioning strategies will therefore need to be employed during a baby's awake time. To help prevent a flat spot from forming, you want to frequently change the position your baby is in during awake hours. Try the following repositioning strategies to help decrease the chance of plagiocephaly occurring:

  • Lots of tummy time

    • Check out our Tummy Time Blog Post for more information and ideas for tummy time: Tummy Time Blog

  • Supported sidelying on the ground

  • Holding your baby at your shoulder or in your arms with their belly toward the ground

  • Holding your baby in an infant baby carrier

  • Holding your baby in supported sitting on the ground*

  • Sitting with support from a Boppy pillow*

  • Using a baby seat device*

    • We recommend the Fisher Price Sit-Me-Up chair or the UpSeat

    • Limit time to 15 minutes per day

  • Change the side of the crib your baby's head is on every other night/week

*Sitting activities should only be utilized for babies older than 3-4 months and who have adequate head control to keep their head up and protect their airway

Treatment for plagiocephaly depends on your baby's age and the severity of their plagiocephaly. For babies less than 6-months-old, caregiver education in repositioning and environmental adaptations is typically the recommended treatment. For babies older than 6 months or older than 4 months with severe plagiocephaly, cranial remolding therapy (use of a cranial helmet) is typically recommended. A majority of babies with plagiocephaly can avoid needing a cranial helmet with consistent repositioning therapy. Repositioning therapy includes all of the above prevention strategies, with a few additions/modifications based on a baby's specific needs.

Cranial remolding therapy is the use of a cranial orthosis (helmet) to redirect cranial growth into voided areas. This helps create a round, symmetrical head shape. Cranial orthosis treatment is typically initiated between 4-6 months of age and continues for 2-7 months depending on severity. Cranial helmets must be worn 23 hours per day.


The content in this blog should not be used in place of medical advice/treatment and is solely for informational purposes. All activities/exercises posted in this blog should be performed with adult supervision, caution, and at your own risk. Big Leaps, LLC is not responsible for any injury while performing an activity/exercise that has been posted on this blog. If you have any information on the content of our blog, feel free to contact us at


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