There are many different ways that Positional Plagiocephaly can be caused....

• Back Sleeping:  This is said to be the most common cause of positional plagiocephaly and positional brachycephaly (see the HEAD SHAPES section).  We have all heard of the "Back to Sleep" campaign, if fact for most parents, it was drilled into your heads long before your baby was born.  We place our babies on their backs to sleep, which for a newborn is the majority of the day, then we proceed to place our babies (on their backs) in car seats, swings, bouncy seats, carriers, and such.  No wonder their poor little heads get flat!  Here again, I must stress the importance of TUMMY TIME while baby is awake and supervised.  Most babies aren't thrilled with this, but with lots of practice, and someone to play with while they're down there, it should come eventually.  It would be beneficial if books, pamphlets, doctors, etc. used the phrase "Back to Sleep, Tummy to Play", as tummy time is essential, not only to help prevent a flat head, but to encourage baby to use his upper body muscles in order to reach milestones "on time".  *I will never discourage parents from putting their babies to sleep on their backs, as studies show a significant S.I.D.S  decrease since the Back to Sleep campaign was put in place!*

• Inutero constraint & Multiple Births:  If you have twins, triplets, or more(!), a big single baby, or even a small uterus, inutero constraint is likely a major factor in your child's case.  In multiple births, baby "A" is usually the one with the squished head, but not always.  Because baby "A" is pushed down into the pelvis, s/he's head likely came into contact with the pelvis for several weeks.  When baby is unable to move around to a different position the soft head will flatten against the hard pelvic bone.  Same applies with a big baby, head down.  For us, our daughter "dropped" quite early, so she was head WAY down for several weeks.  Again, with multiples, 2 babies may have been sitting head to head, etc...

• Torticollis:  "Congenital Muscular Torticollis is most commonly caused by positioning in utero or by an injury to the Sternocleidomastoid muscle on one side of an infant's neck during birth" (definition from torticolliskids).  The injury causes the baby to turn their head to one side, and or lack range of motion.  In turn, baby often develops a flat spot to the back of the head from keep his/her head in one spot all of the time.  Physical therapy is a must to properly heal most cases.

• Premature Birth:  Preemies are prone to head flattening because of their extra soft skulls.  In the last few weeks of a normal pregnancy, the skull bones harden dramatically.  But when baby is born early, his head is exposed to hard flat surfaces before it is ready, and easily flattened.  Special care needs to be taken to reposition these early arrivals.

• Uterus Abnormalities:  Some uterus abnormalities are thought to contribute to a baby developing plagio.  Obviously, a small uterus can lead to crowding, but some believe that a "tilted" uterus, fibroids and other problems may also be major factors.  Discuss any of these possibilities with your doctor, especially if it will help you with fighting your insurance company.

• Genetics:  Genetics is a definite possibility in some cases.  Look at your own head, or anyone else in the family.  It may just be that your baby inherited Granny Sue's prominent forehead (or whatever!), and you didn't realize it because Granny has a full head of hair, and baby doesn't! :o)  Some researchers also suggest that genetics may play a role in some actual plagio cases.  I don't know of any supporting studies of this.