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Postural plagiocephaly, also known as positional plagiocephaly, results from external pressure on the skull rather than premature fusion of cranial sutures. This condition typically leads to flattening of the back of the head, with one side more affected than the other. In some cases, it can also cause facial asymmetry.
Newborn skulls are soft and flexible, with sutures that allow the head to mold during birth and accommodate brain growth. In the early months, babies often lie in the same position for extended periods, shaping the skull accordingly. Since 1994, guidelines in the United States have recommended back sleeping to reduce the risk of sudden infant death syndrome (SIDS), which is about ten times higher with stomach sleeping. This practice has increased cases of postural plagiocephaly, as prolonged back sleeping can lead to a "square watermelon" head shape if positions aren't varied every three to four hours.
Other factors include fetal positioning in the womb, premature birth, difficult deliveries, vision imbalances, neuromuscular issues, and congenital torticollis—a condition where neck muscles stiffen, limiting head rotation and causing habitual tilting to one side, which exacerbates asymmetry.
The condition may manifest as flattening on one side of the back of the head, with the opposite forehead also appearing flat. From above, the head might resemble a parallelogram, with misaligned ears, uneven eye positions, and a rising crown from forehead to back.
Postural plagiocephaly is not a disease and does not hinder brain development, as long as space for growth remains available.
Yes, the condition often improves. By 4-6 months, babies gain better neck control, allowing varied positioning. Studies indicate significant improvement after six months, even in cases involving torticollis with appropriate treatment.
While not a medical necessity, addressing postural plagiocephaly focuses on appearance to prevent potential psychological effects later. Early intervention includes repositioning to avoid flat spots and rule out issues like torticollis or suture fusion. A molding helmet, customized like a sports helmet, can be effective before age one by relieving pressure on flat areas and guiding growth. After one year, the skull hardens, making shaping difficult.
Surgery is not required, as this is not a disease. If appearance remains a concern, procedures might be considered between ages 7-9.