What is the difference between Positional
Plagiocephaly and Craniosynostosis?
Plagiocephaly is strictly the flattening of the skull due to
some sort of external pressure. It can be caused prenatally
by cramped quarters, or postnatally through back sleeping,
or encouraged by a case of torticollis (tight neck muscle).
Plagiocephaly can be treated with helmet therapy, usually
along side a physio therapy regimen.
Craniosynostosis is the premature fusion
of one or more cranial sutures. This condition will cause
the head to take an abnormal shape as it grows.
Craniosynostosis can only be helped with surgery. A CT scan
may be required to properly diagnose this condition. [See
Q: How do I know my
baby has plagiocephaly?
A: Plagiocephaly can
range from mild to moderate to severe. The average head
shape that will likely require treatment will show the
following symptoms. Please note that although many
doctors can tell the difference between
by sight. CT scan or
x-rays may be required. NOT ALL DOCTORS WILL DO THESE TESTS if baby
shows all of the "classic" symptoms.
- moderate to severe flatness at the back/back-side of
Scaphocephalic head shape (long and narrow)
Brachycephalic head shape (entire back of head is
- the forehead on the affected side may be more
prominent than that of the unaffected side.
- the ear on the affected side may be pushed more
forward than the ear on the unaffected side.
- one eye may appear larger than the other.
- the nose may appear pushed to one side.
- one cheek may look fuller than the other.
- the baby may tilt the head to one side and lack
range of motion (due to
torticollis - tightness of a
Q: Does the odd shape
of my babyís head hurt her? Is it effecting her
A: It is unlikely that
the shape of your babyís head is hurting her. This is a
common question, and as many times as it has been asked,
there has been a dozen responses testifying that these
babies are generally very happy. Happy babies arenít
As far as
plagio. affecting development, well, yes and
no. The deformation itself is not hampering brain growth,
nor is it causing any sort of mental disabilities (as far as
studies can claim to date), however the torticollis that is
commonly coexistent with the
plagio. my be slowing
development. It is important to find a good childrenís
physical therapist. It may take several months to correct
torticollis, and rarely a simple surgical procedure is
necessary to loosen the tight muscle. Please read more
torticollis by clicking the link to the left.
Please keep in mind that one short study came to the
conclusion that children that were left untreated showed
lower grades in school. It was inconclusive as to whether or
not it was the
plagio. itself that was the main factor in
this, or the self esteem of the child due to his/her
Q: Do I need to seek
treatment, or will my babyís head round out on itís own?
This is a difficult question to answer. Many factors are
What is the age of the child? If your baby is under 3
months of age, aggressive positioning techniques may help
round out babyís head. After this point, you should talk
to a doctor about a timeline in which intervention may be
necessary. Remember, the earlier you start treatment, the
faster you will see results. Treatment should be
started before 1 year of age and can be started up
to 24 months of age (*depending
on the type of helmet used - check with your orthotist!!*)
What is the severity of the deformity? Very mild cases
are likely going to either heal on their own (if no
torticollis is involved, and positioning methods are
used), or will "hide" once the child has grown a
full head of hair.
If the case is moderate to severe, treatment is likely
Ultimately, it is a decision the family must make
together with the guidance of a doctor that is well versed
on the topic of plagiocephaly. The well being of the child,
both present and future is obviously the goal here.
Q: My doctor says that
this condition is strictly cosmetic and that treating it
would be like giving my baby a nose job!!
This is not true. A cosmetic treatment would alter a normal
looking appearance. Therapy with a cranial molding
helmet/band is considered to be reconstructive, thereby
normalizing the appearance of the anomalous head shape.
Q: What will happen if
we donít treat this condition?
A: Studies are still
few and far between on this topic. It is still somewhat
unclear as to what may happen, as this is still a relatively
Many doctors state that if left untreated, the child
would develop normally, but there is evidence suggesting
that vision and jaw alignment problems may occur in moderate
to severe cases (keeping in mind that plagio. is not just a
flattened head, but the shifting of all cranial bones).
Please also consider the self esteem of the child in
future years. I have read statements from adults who
suffered as teens because of their deformed head shapes.
Q: Which doctor should
I have my pediatrician refer me to?
A: There are a handful
of doctors that will diagnose and prescribe treatment.
- craniofacial plastic surgeons
When seeking out a specialist, try to find one that
focuses on infants.
Q: If we decide to go
with helmet therapy, how long will it take to round my babyís
A: It depends. If you
go with the "DOC Band", Cranial Technologies gives
an average treatment time frame of 4.5 months. There are
also several different individually made helmets and bands
out there. Each of these devices are made by private
manufacturers, so to get an accurate time frame, you should
talk to the orthotist who makes that particular device.
Age and Severity are also major factors in the
amount of time it will take. The younger the child, the
faster you will see results. Same goes with severity - the
flatter the head, more asymmetric the features, etc., the
longer the treatment time.
Q: My baby is already a
year old. Is it too late?
A: Treatment is all
dependant upon the growth of the child. Babies grow the
fastest in the first 7.5 months of their lives. After this
point, growth slows some, and then slows even more after
their first birthday. This is why treatment is the most
effective in the first year. Some helmet manufacturers
will start treatment after the first birthday, while some
stand firm that it is too late. Cranial Tech. will
"band" a child up to 24 months of age in most
cases. Check with your local helmet program.
Q: How much does
treatment cost? Will my insurance pay?
A: The cost all depends
on where your baby will receive treatment. Even "Name
Brand" bands/helmets vary in price from location to location. I have heard
of helmet prices as low as $500.00, ranging all the way up
to $3500.00 (average DOC Band price seems to range in the
$3000 area). But donít get your hopes up for that $500.00
Insurance companies can be very stubborn. Call and ask
your provider if this is something they cover. If they give
you a flat-out "no", ask them to check under
"durable medical equipment". If they still say no,
prepare yourself for a fight. It may take some time, and you
might consider starting treatment before approval, if you
have an older child. On your part it may take several
appeals, and hours of research, but these fights have been
won over and over in the past. Please check our insurance
Q: What is better, the
DOC Band, the STARband,
or the helmet?
A: There is no fair
answer to this question. The DOC Band,
STARband and several helmet
styles have been proven to work. The best thing for you to
do to answer this question is to talk to your closest
Cranial Technologies clinic, contact Orthomerica,
and talk to your local helmet
provider. Ask about casting procedures, how that specific
helmet works, estimated time that your child will have to
wear the helmet, how often they do adjustments to
accommodate the growing head, how many babies they have
treated in the past, etc. Some parents have found that the
local helmet maker recommends using the DOC Band because
his/her experience is inferior to that of Cranial Tech.ís.
My childís head and band/helmet stink! How do I get rid of
A: Perspiration is
normal and can be excessive in the first couple of weeks. Be
sure to maintain a daily cleaning schedule. Ask your
orthotist for any cleaning suggestions. Here are some
Remove the band/helmet for the recommended time. Wash the
childís head using a fragrant shampoo (L'Oreal for Kids,
Head & Shoulders). Scrub the inside of the band/helmet
with the recommended cleaning agent. (DOC band users note:
Use only isopropyl alcohol on the inside of the band. Other
products can leave a residue and cause skin damage to your
childís head). Place the band/helmet in direct sunlight
for the remainder of the time off period. This will
help to reduce smell, and to "sun bleach" any
Q: People are staring
when we go in public. How do you handle this?
A: People are curious
about what they do not know about. Keep a smile on your face
and talk to your child. Decorate the band/helmet to make it
look less medical. Use paint, stickers, rub on transfers,
Velcro bows, etc to make it look more kid friendly. Think of
your time in public as an opportunity to educate others
about plagio. Consider creating a flyer to hand to
people. See the Let's
Q: What is
"repositioning"? How do I do it? Will it help?
A: Repositioning is
your effort to keep the childís head off of the flat spot.
Any external forces (floor, car seat, swing, crib
mattress.....)should be applied to the area that
"sticks out". Aggressive repositioning in young
infants can help reshape the head.
When lying down or sitting, use a rolled towel under the
shoulder of the effected side so that the head will
naturally fall to the opposite side. When sleeping, use the
rolled towel under the bed sheet. Also, mini "Boppy
pillows" or other neck rings can also be helpful to
change the babyís position. *Always
be careful of the items you put in your childís crib so
they do not cause a suffocation risk.*
Repositioning may help to reshape the heads of very young
babies. If your doctor suggests repositioning, ask him/her
for a "timeline" at which point other intervention
may be necessary. Remember that repositioning does not
always work and the earlier treatment is started, the sooner
you will see results. I would recommend taking photos of
your babyís head (both sides, front and top views) the day
you start repositioning. This will help you make a fair
assessment as to whether or not positioning methods are
helping. Compare photos in 4-6 weeks time. See the Repositioning
Techniques link. [Also see
Q: What is torticollis?
Do all babies with plagiocephaly have
A: Torticollis is a
condition where the neck muscles on one side of the child
are tighter and therefore do not allow a normal range of
motion. Many, but not all children with plagio have tort. If
your child shows a preference in which way she turns her
head, this may lead to the flattening of the skull behind
that side. Seek help from a physical therapist to stretch
the neck muscles to gain full range of motion. Check
Q: Where can I find more information about
head shape deformities?
A: Please see the FAQs pages and 'Get Real Help' pages at