Cleft & Craniofacial Team at St. Mary's


Positional plagiocephaly

Positional plagiocephaly refers to an abnormal head shape that can be a result of positional molding. It is important to distinguish positional plagiocephaly from a more serious condition called craniosynostosis.


Positional molding can occur as a result of your child sleeping on the back of his/her head, the baby’s prolonged position in the womb, or from torticollis. The latter has been much more common as sleeping on the back and not the tummyis the recommended position by the American Academy of Pediatrics. The change in head shape occurs because there is constant pressure to one side of the head causing it to be flat. Children who are premature or the result of multiple birth pregnancy may have a higher incidence of plagiocephaly.


Positional molding, if detected early enough, may improve on its own within the first six months of life with positional changes alone. If your child has torticollis, neck-stretching exercises will be provided in addition to the positional changes. It has been our experience that if the deformity is moderate or severe after six months of age, then helmet therapy might be indicated. Helmet therapy does not usually work after the child is 14-18 months of age. If helmet therapy is delayed after this age, extensive cranial surgery is the only way to fix an abnormal head shape.

If helmet therapy is prescribed, your child would need to wear the helmet 24 hours/day, everyday. It may be removed for short periods for airing or bathing. The average treatment time is 3-4 months. Most children are able to tolerate helmet therapy within the first days of use.

To learn more about positional plagiocephaly, please call 804-287-7396 to speak with our nurse coordinator, Linda Shait, RN.