Kayla Gallegos, DPT

Plagiocephaly is when one side of the back of an infant’s head is flattened compared to the other side. If left unaddressed, it can change the structure of the head and face, such as protrusion of the forehead or shifting of the ear and cheek. Plagiocephaly treatment can be accomplished in Physical Therapy through positioning, addressing cervical range of motion, promoting typical development, and educating parents. In some cases, a cranial remolding orthosis or helmet can assist in re-directing the cranial growth and promote symmetry in the skull. In this post, we will discuss techniques and tips to assist in the prevention of Plagiocephaly.

Tummy Time

Tummy time allows infants to be off of their head completely. It is also great for motor development and strengthening the neck, back, and arm muscles! The APTA Academy of Pediatric Physical Therapy recommends allowing your baby to play on their tummy with supervision at least three times a day. Pro Tip: if your infant does not like tummy time, try elevating their upper body such as on your chest or over a boppy.

Encourage Infant to Look Both Directions

Encouraging your baby to turn their head both ways can not only help prevent Plagiocephaly, but it can assist in the prevention of Torticollis. Plagiocephaly is often associated with Torticollis. Torticollis is when the sternocleidomastoid muscle on one side of the neck is tight and causes the infant to tilt and rotate their head to the side. In this prolonged position, it can sometimes lead to changes in head shape. There are many ways to encourage your baby to turn their head in both directions. Some include:

Alternate which arm you hold your baby in during feedings
Put toys your baby enjoys on both sides of them during play
Alternate the head of the crib
Alternate the orientation of the changing table

Parents can encourage their babies to look different directions by changing the orientation of the changing table.

Your baby will tend to turn their head toward the sound of your voice. Switching the head of the crib and the orientation of the changing table allows them to practice turning their head in both directions and can assist in preventing a flat spot from developing. If you notice your infant prefers to turn their head to one side, start placing toys opposite their preferred side to encourage rotation to the non-preferred side.

Minimize Container Time

When placed in containers, such as car seats, strollers, rockers, or bouncers, babies stay in the same position for the duration of time they are in the container. Containers are helpful for transportation and safety but they limit movement of the baby’s head and body. To assist in the prevention of Plagiocephaly, limit time in car seats and strollers to only the time your baby is being transported and minimize the amount of time spent in other containers. Instead of spending prolonged time in containers, hold your baby in your arms, allow them to play freely in a playpen with supervision, or place them in tummy time with supervision.

Center Baby’s Head and Body

Keep your infant’s head and body centered so neither side is tilted for a prolonged period of time. For example, if you notice your baby’s head or trunk is tilted in their car seat, you can place towel or blanket rolls to assist in centering their head and body. In the car seat, make sure the roll is to the side of the head and not behind to avoid neck injury.

A small rolled blanket is used here to help center baby’s head while in the car seat.

Consult your Physical Therapist with Questions

If you notice flatness on your baby’s head, tilting of the head, or they show difficulty turning their head to one side, consult your physical therapist. At Ability Innovations, you can call to set up a consultation for free. Physical therapists can assist in parent education, addressing your infant’s motor skills, strength, range of motion, and can provide referrals for a cranial orthosis when necessary.

References

Aarnivala, H., Vuollo, V., Harila, V., Heikkinen, T., Pirttiniemi, P., & Valkama, A. M. (2015). Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial. European journal of pediatrics, 174(9), 1197–1208. https://doi.org/10.1007/s00431-015-2520-x

APTA. (2018). APTA pediatrics - congenital muscular torticollis clinical practice guideline & implementation resources. PediatricAPTA.org. https://pediatricapta.org/clinical-practice-guidelines/Congenital-Muscular-Torticollis.cfm

GUIDE: Physical therapy guide to container baby syndrome. Choose PT. (2018, December 10). https://www.choosept.com/guide/physical-therapy-guide-container-baby-syndrome

Tummy time 101: When to start and why it’s so important. Tinyhood. (n.d.). https://www.tinyhood.com/expert-articles/labor-birth/newborns/tummy-time-101-when-to-start-and-why-it-s-so-important

Tips to prevent plagiocephaly