Two Different Conditions
Parents are often referred, or self-refer, with concerns about their baby's head shape. It is important to distinguish between two quite different conditions:
- Positional (deformational) plagiocephaly — a flattened area of the skull, most often at the back or one side of the head, caused by sustained pressure while the skull is still soft (commonly from time spent lying on the back). This is common, benign, and not a sign of any underlying problem with the brain or skull sutures.
- Craniosynostosis — a very rare and uncommon condition in which one or more of the skull's growth sutures fuse prematurely, changing head shape. This may require surgical management, and the most important step where it is suspected is a proper multidisciplinary team assessment.
Assessment
Assessment includes the pattern of flattening, the shape and position of the ears, forehead and face when viewed from above, and examination for a palpable ridge along a suture line — a possible sign of craniosynostosis. Most infants seen with head shape concerns have straightforward positional plagiocephaly, which can be confidently distinguished on clinical assessment, occasionally supported by imaging where there is diagnostic uncertainty.
Managing Positional Plagiocephaly
- Increased supervised tummy time during awake hours
- Regularly alternating the baby's head position and the orientation they face in the cot
- Physiotherapy where reduced neck movement (torticollis) is contributing
- Helmet (cranial orthosis) therapy is considered in more pronounced cases, usually referred to a specialist orthotic service
Positional plagiocephaly usually improves significantly with these measures, particularly when addressed early, and does not require surgery.
When Craniosynostosis Is Suspected
Craniosynostosis is very rare and uncommon. Where assessment raises concern for craniosynostosis, a proper multidisciplinary team (MDT) review is the natural next step — bringing together the specialist input needed to confirm the diagnosis and plan the right care, including cranial vault surgery at a designated craniofacial centre where this is indicated. Mr Naparus trained in cleft, craniofacial and paediatric surgery at Great Ormond Street Hospital and works closely with specialist craniofacial colleagues as part of this multidisciplinary approach.