Clinical Assessment of Head Shapes

Does my baby have a flat head?

Baby head shapes associated with flat head syndrome/plagiocephaly

Parents often notice mild deformities in their babies’ skulls and naturally begin to worry. Typically, this is most evident when looking at their babies’ heads from above (the bird’s eye view) while the hair is wet.

It is perfectly normal for your newborn baby to have an initially irregular head shape. However, irregular or flat head shapes caused by the birthing process should begin to resolve over a period of a few weeks.

If any flat spots or irregular shaping are not improving or are more noticeable by 3-4 months of age, conservative treatment such as repositioning, supervised tummy time, or physical therapy may be recommended. Orthotic treatment is common at 4-6 months of age for infants with persistent moderate to severe deformities.

Deformational Plagiocephaly (DP) — Primary deformity is asymmetry.

Presents as an asymmetrical (uneven) head shape. The back of one side of the head will be
flattened, often pushing the forehead and ear on the same side forward.

  • The most common type of skull deformity in infants
  • Usually noticed by caregivers at about six to ten weeks of age
  • Characterized by an asymmetrical skull shape
  • Unilateral occipital flattening
  • The earis positioned more anterior on the side of the occipital flattening
  • The forehead may be asymmetrical and is positioned more anteriorly on the side of the occipital flattening
  • Facial asymmetry may be present
  • lt may be accompanied by torticollis, limited neck range of motion, weakness, and preferential head positioning

Evaluation by a physician or orthotist is recommended for deformational plagiocephaly Types 3-5.

TYPE1 - Normal

CLINICAL FEATURES

  • Minimal posterior flattening

CLINICAL RECOMMENDATIONS

  • Repositioning & tummy time
  • Monitor for improvement/progression

TYPE2 - Mild

CLINICAL FEATURES

  • Posterior flattening
  • Minimal ear shift

CLINICAL RECOMMENDATIONS

  • Repositioning & tummy time
  • Monitor for improvement/progression

TYPE3 - Moderate

CLINICAL FEATURES

  • Posterior flattening
  • Ear shift
  • Forehead asymmetry

CLINICAL RECOMMENDATIONS

  • Repositioning & tummy time
  • Orthotic evaluation recommended

TYPE4 - Severe

CLINICAL FEATURES

  • Posterior flattening
  • Ear shift
  • Forehead asymmetry
  • Orbital, cheek, face, or jaw deformity
  • Frontal and /or parietal sloping

CLINICAL RECOMMENDATIONS

  • Repositioning & tummy time
  • Orthotic evaluation recommended

TYPE5 - Very Severe

CLINICAL FEATURES

  • Posterior flattening
  • Ear shift
  • Forehead asymmetry
  • Orbital, cheek, face, or jaw deformity
  • Frontal and/or parietal sloping
  • Temporal bossing and increased cranial vault height

CLINICAL RECOMMENDATIONS

  • Repositioning & tummy time
  • Orthotic evaluation recommended

Deformational Brachycephaly (DB) — Primary deformity is disproportion.

Presents as an abnormally wide head shape resulting from a central flattening of the back of the head. You may notice a bulging forehead and increased height of the back of the head in the side view. This shape can also be asymmetrical.

  • Central occipital flattening
  • Increased cranial vault height posteriorly. The head is excessively wide for its length
  • lt may be accompanied by a prominent, bossed forehead

Deformational brachycephaly with asymmetry

  • Combination of brachycephalic and plagiocephalic characteristics
  • The shape is disproportionately wide for its length and is also asymmetrical
  • lt may or may not include asymmetries to the forehead and facial structure

Evaluation by a physician or orthotist is recommended for deformational plagiocephaly Types 3-5.

TYPE1 - Mild

CLINICAL FEATURES

  • Central occipital flattening

CLINICAL RECOMMENDATIONS

  • Repositioning & tummy time
  • Monitor for improvement/progression

TYPE2 - Moderate

CLINICAL FEATURES

  • Central occipital flattening
  • Widening of the posterior skull
  • Frontal flattening or bossing

CLINICAL RECOMMENDATIONS

  • Repositioning & tummy time
  • Orthotic evaluation recommended

TYPE3 - Severe

CLINICAL FEATURES

  • Central occipital flattening
  • Widening of the posterior skull
  • Frontal flattening or bossing
  • Frontal and/or parietal sloping
  • Temporal bossing and increased cranial vault heigth

CLINICAL RECOMMENDATIONS

  • Repositioning & tummy time
  • Orthotic evaluation recommended

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