Deformational plagiocephaly occurs when a flat spot develops on one side of the baby’s head or the back of the head. It usually happens when a baby consistently sleeps in the same position, which can occur with back sleeping and car seat sleeping. There are, however, other scenarios that can lead to the development of this abnormal skull shape:

  • A tight space in the uterus, which is common in pregnancies of twins or other multiples.
  • Muscular torticollis, a congenital condition in which the neck muscles are extremely tight, forcing the baby’s head to stay in one position.
  • Premature birth, which result in babies with softer skulls who, after birth, typically spend a lot of time in the hospital on respirators with their heads in the same position.


Deformational plagiocephaly is very common and can typically be diagnosed with a thorough physical evaluation by a clinician who specializes in treating craniofacial deformities. Because the condition looks similar to craniosynostosis, accurate diagnosis by an experienced team is extremely important to managing your child’s condition.

The experts at the North Carolina Cleft and Craniofacial Center will be able to differentiate readily between these conditions. In rare cases, our medical team may use a CT scan to confirm the diagnosis and further evaluate your child’s condition. It is important that cases of craniosynostosis be identified early, as these conditions often require surgical treatment, and if left untreated, may result in elevated pressure in the skull.


In most babies with deformational plagiocephaly due to sleeping position, simple repositioning of the child will resolve the problem.

If repositioning is not successful in addressing the problem, or if the deformation is severe and lasts longer than six months of age, helmet therapy may be required.

Helmet therapy works by fitting the skull tightly with a specially designed helmet in all areas except where it is flat. Leaving extra room around the flat area of the head allows the skull and brain to grow back into their normal shape.

Deformational plagiocephaly can be associated with torticollis, or a tight neck, and can be seen when there are structural anomalies, such as fused or hemivertebrae, or most commonly as a completely isolated anomaly.

In the majority of cases, physical therapy to straighten and stretch the neck will correct the head shape and posture, but in more severe cases, helmet therapy can be used.