RefHelp - NHS Ayrshire and Arran
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Positional plagiocephaly
Warning
- Positional plagiocephaly, or asymmetrical head shape, affects about one in five babies and results from prolonged adoption of a particular head position.
- It is seen following oligohydramnios, multiple pregnancies, sternocleidomastoid tethering (can cause torticollis), prematurity, and in infants with neuro-muscular disorders.
- A variation is Positional Brachycephaly where the occiput is largely symmetrically flattened and becomes much broader, sometimes with a taller head shape sloping down from the occiput toward the forehead.
- Craniosynostosis results from premature fusion of sutures of the skull. It is very rare with a frequency of around 1 in 10,000 live births.
| Feature | Positional plagiocephaly | Craniosynostosis |
| Incidence | Common (1 in 100) | Rare (1 in 100 000) |
| Palpate skull sutures | Sutural ridge not palpable | Sutural ridge palpable |
| Check ear position | Ear pushed forward on the side of occipital flattening | Ear placed backwards on the side of occipital flattening |
| Assess facial symmetry | Forehead is protuberant on the side of occipital flattening | Forehead is symmetrical |
| Assess hair growth pattern | Unilateral bald spot on the side of the occipital flattening | Absent |
| Management | Can be managed in Primary Care | Refer to Secondary Care |
- Referral to Physiotherapy for positional plagiocephaly as per referral pathway (or view in PDF format)
- Referral to General Paediatrics via SCI Gateway for concerns regarding craniosynostosis or developmental concerns.
- Referral to Orthopaedics via SCI Gateway – for suspected torticollis.
Referrals to General Paediatrics should be made via SCI Gateway.
Please note, these are vetted in a timely manner so the priority status of a referral may change upon review.
- In most cases simple positioning measures will gradually improve head shape over time and reassurance is all that is needed.
- Residual flattening will become less noticeable as the child gets older and with hair growth.
- Families should informed that this is cosmetic and will not result in ‘pressure on the brain’ or any developmental problems.
- Helmets are not currently provided by the NHS as there is insufficient evidence to support their use.
Carer information leaflet
NHS Ayrshire and Arran. Preventing positional plagiocephaly. Information for parents.