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Causes of Head Deformities

Misshapen heads can arise for different reasons. They can be caused by premature fusion of the skull sutures (craniosynostosis). This condition is rare and often needs surgical correction, which is why our surgeons are eminently qualified to diagnose it. In contrast, positional changes are much more common.

Positional plagiocephaly (“skewed-head syndrome”) and brachycephaly (“flat-head syndrome”) are caused by external pressure on the skull. Because they occur after the baby has been born, and because they are different to birth-related deformities, they may not improve by themselves.

The increased incidence of plagiocephaly is largely due to the “Back to Sleep” campaign, designed to reduce the incidence of “cot death”. Since 1994, many paediatric associations have been recommending back sleeping positioning as a means of avoiding Sudden Infant Death Syndrome (SIDS).


Plagiocephaly and Brachycephaly

Positional plagiocephaly (“skewed-head syndrome”) is simply defined as a deformity or asymmetry in the skull shape, which typically occurs within the first 3-6 weeks of a baby’s life.

Whereas it is completely normal for a skull to have minor abnormalities or small bumps, plagiocephaly refers to a large, unusual area of flattening.

The skull is made up of several plates, which are still soft and pliable before 6 months. This means that the shape can be altered by external pressures, giving it a deformed or flattened look. In most cases, this is at the back of the head.

Brachycephaly is similar to plagiocephaly and is identified by flatness across the full width of the back of the head. Typically, brachycephaly results in a shorter, wider than average head shape.

Signs of Positional Plagiocephaly

Although most incidents of plagiocephaly occur within the first couple of weeks of life, they are often noticed by parents between 6 and 8 weeks. Some babies are born with a flat head, although this is usually a temporary deformity caused by the pressures of leaving the mother’s womb. In most cases, these birth-related deformities get better by themselves.

Positional plagiocephaly can best be spotted by looking down on the baby’s head from above.

  1. Parallelogram-shaped skull when viewed from above. Flattening on one side at the back of the head, with a bulge in the forehead (on the same side) and flattening (on the other side).

  2. Unequal positioning of the ears: forward positioning on the flat side, and backward positioning on the opposite side.

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How Serious is it?

A small degree of asymmetry can be quite normal. It may also become invisible in time because: (a) the deformity is unlikely to get worse after 6 months of age, and (b) asymmetry is much less obvious in bigger heads.

Nonetheless, even if the baby’s head is severely deformed, it is very unlikely that there will be medical consequences. Brain function and development will not be affected.

However, patients with severely asymmetrical ears can develop bite anomalies. This is because the lower jaws mostly grow in the area of the jaw joints, which, in turn, are part of the boney complex of the inner ear.

So, in sum, we could say that positional plagiocephaly is mainly a cosmetic problem. But, if children grow up with significant facial asymmetry, then this can lead to psychological problems later in life. And, by then, it is almost impossible to treat satisfactorily.

Our expert surgeons will thoroughly assess your baby’s condition and give you all the information you need to make an informed decision whether or not to proceed with any treatment, helmets or otherwise.

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