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Plagiocephaly

Key sources
The following summarized guidelines for the evaluation and management of plagiocephaly are prepared by our editorial team based on guidelines from the Congress of Neurological Surgeons (CNS 2016) and the Canadian Paediatric Society (CPS 2011).
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Guidelines

1.Screening and diagnosis

Diagnosis: diagnose plagiocephaly on the basis of clinical examination.
A
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2.Diagnostic investigations

Clinical evaluation: obtain evaluation for craniosynostosis, congenital torticollis and cervical spine abnormalities as part of the examination of a patient with plagiocephaly.
B

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  • Diagnostic imaging

3.Nonpharmacologic interventions

Physical therapy
Offer physical therapy over repositioning education alone to reduce the prevalence of infantile positional plagiocephaly in infants ≥ 7 weeks of age.
B
Offer physical therapy over using a positioning pillow in infants with positional plagiocephaly to ensure a safe sleeping environment and comply with AAP recommendations.
B

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  • Repositioning

  • Helmet therapy

4.Preventative measures

Positioning
Advise positioning of the head to encourage lying on each side in the supine position for the prevention of plagiocephaly. Recognize that more effort may be required for the child with a strong positional preference to lie more on one side of the head.
B
Advise prone positioning during awake time (tummy time) for 10-15 minutes at least TID for the prevention of plagiocephaly.
B