Treatment of positional plagiocephaly

The most common forms of treatment are repositioning therapy and cranial orthosis therapy (wearing a band or helmet). Health visitors and GPs in the UK are not uniformly experienced with, or knowledgeable about, plagiocephaly and will often tell parents that the head shape will round out on its own as the child grows and as it spends less time on its back, or that future hair growth will cover it. They often, therefore, advise non-intervention. While mild cases often improve spontaneously over time, in severe cases, most parents prefer to undertake some kind of active treatment.

Repositioning
Repositioning techniques are best used when a baby is under six months old. After six months, it is much harder to control the side that the baby sleeps on, so repositioning cannot be as effective. Repositioning is simply the concept of ensuring that the baby does not rest on the flat spot. By removing the external pressure, the flat area will “round out” as the head grows.

Before trying repositioning, it is important that the baby be checked for torticollis. If the baby has torticollis, physiotherapy should be pursued to stretch the neck muscles and ultimately resolve the condition; just ask your GP for a referral to a paediatric physiotherapist, or check your private medical insurance, as this will often cover physiotherapy in infants.

Please see the repositioning techniques page for more information on how to carry out effective repositioning. There are also products that help repositioning efforts on the Repo products page.


Cranial orthoses (bands/helmets)
Helmet or band treatment is best started at an early age, usually by six months. Although some bands and helmets can be started as late as 24 months, the effectiveness is greater the younger the baby is.

Treatment works by capturing the rapid growth of the baby’s skull and redirecting it to achieve symmetry. Since the vast majority of cranial growth (approximately 80%) is achieved in the first twelve months of life, the greatest amount of correction will be achieved during this time. Although many children do receive good results with a cranial orthosis in the second year of life, the length of treatment is longer and the correction may not be as great.

For treatment in the UK, you will usually need to self-refer to a private helmet specialist, but there have been some NHS referrals. There are currently three private providers and one NHS providers of helmets in the UK. (Another NHS hospital is undertaking a trial). For more information on availability, costs and helmet type and design, see the Helmets page. For information on the orthotists who provide treatment for each of these bands/helmets, please see the Clinics and specialists page.

The length of treatment time in a helmet is dependent on several things:

• the type of condition - plagiocephaly is corrected more quickly than brachycephaly;
• the age at which the baby starts the therapy - the younger the better;
• the rate at which the baby grows; the severity of the deformity;
• the complexity of the head shape - not all heads are just flattened, some have facial asymmetry, ear misalignment, are high on top, or twisted at the back, etc.; and
• the amount of growth space put into the helmet by the supplier - this may vary according to the individual being treated, and according to the supplier used.

Typically though, most babies will complete treatment within 3- 6 months.