Management of Positional Plagiocephaly in Children

Initial Management at Presentation

  • Repositioning: The primary treatment recommendation of the AAP is to use positioning to avoid continued compressive forces being applied to the area of flattening.
  • Prone positioning, or “tummy time,” with goal of 30 minutes per day: This insures that no compressive force is being applied during the time on the tummy and has the added benefit of focusing the family on the causative factor for the plagiocephaly.
  • Treat torticollis if present: If torticollis is present, it will lead to a preferential head position that results in the child lying on the flat spot. Early treatment is best to eliminate this contributing factor for the plagiocephaly.

Adjunctive Therapies

  • Cranial orthosis, or “molding helmet”: These helmets are fabricated to insure that no pressure is being placed on the area of flattening and that use of the helmet will direct subsequent growth to reverse the parallelogram.
  • Surgery rarely used for refractory cases: There is rarely a role for surgery for positional plagiocephaly. It can usually be treated successfully with positioning therapy, physical therapy, or molding helmets. Surgery has been used in rare cases of positional plagiocephaly with severe deformities that are resistant to nonsurgical measures (23).

Follow-up

  • For repositioning therapy: A child in a repositioning program is seen approximately every month to assess the progress being made and the family’s satisfaction with treatment.
  • For helmet therapy: A child placed in a cranial orthosis needs to have the scalp checked every 1–2 weeks for tolerance. Such checks are frequently done by the orthotist, but examination should be confirmed by the neurosurgeon periodically.