Plagiocephaly in Adults

Plagiocephaly is simply the flattening of one side of the head, causing the skull to look asymmetrical. Plagiocephaly is also known as “Flat Head Syndrome”. This refers to the different types of skull deformations that can occur during infancy resulting in a misshapen or a flat spot on the child's head. Plagiocephaly generally occurs during the first year of a child's life while the skull is still soft and malleable and happens as a result of a baby spending too much time in one position.

Preventative measures can be taken in an attempt to reduce the chance of plagiocephaly, this usually involves positioning a child differently to reduce prolonged time against a flat surface. In more extreme cases; related to birth defects surgical intervention assists in allowing for the brain to grow properly.

If an adult has a case of plagiocephaly it is highly likely that there has been no effect on brain development, any problem in adulthood would only be a cosmetic issue and to solve it with surgery would be extreme and unnecessary.

Types of Plagiocephaly

• Positional Plagiocephaly: The baby's head develops a flat spot/ misshapen head due to the child spending too much time on its back¹
• Brachycephaly: The growth plates in the skull close before the child's birth, causing developmental issues²
• Craniosynostosis: The skull bones fuse early, early treatment can occur³

Plagiocephaly is more likely to occur as a result of positioning and the child's head being against a flat surface for extended periods of time. Around 15 to 20% of infants are thought to present with some level of positional plagiocephaly, with numbers potentially reaching up to 46.6%.⁴

Causes of Plagiocephaly

Flat head syndrome tends to arise from too much time spent with the head in one position, against a flat surface. This comes from a baby being left in one position, on their back for too long. It is very important that infants sleep on their back to reduce the risk of sudden infant death syndrome (SIDS). 

There are other reasons this may occur beyond just laying on the back, these are:

• Torticollis - This is a tightening of the neck muscles, making it difficult for an infant to tilt the head in other directions, hold their head up and perform movements necessary for feeding⁶ 
• Issues in the womb - If a baby is a bit squashed in the womb or there is a lack of amniotic fluid; for cushioning, there can be pressure placed on the baby’s head
• Premature birth - Premature babies are more likely to develop flat head syndrome due to the skull being even softer when born⁷ 
• Premature skull fusing - The skull bones fuse early and so it does not develop properly

In adults plagiocephaly generally stems from uncorrected issues during infancy, this can be compounded by habits in head positioning whilst resting and sleeping which contributes to an abnormal head shape.⁵ 

Plagiocephaly is clearly identified by a ‘flat spot’ on the head or an asymmetrical shape giving the characteristic abnormal skull shape. This can be diagnosed by a medical professional who will examine the infant's head; measure to understand the severity, and decide on a course of treatment.⁸ 

Consequences of Plagiocephaly

Plagiocephaly has no detrimental long-term effects, beyond the appearance of the skull.

There can be issues with finding properly fitting head protection or glasses that sit properly if the ears are misaligned. In adulthood, the main issue that can arise from flat head syndrome is the psychological impact that can occur from self-esteem issues related to an abnormal head shape.

Treatment

Treatment for flat head syndrome generally includes preventative measures of ensuring that a baby’s head and neck position changes when going to sleep, so there is not too much pressure on one side of the head.

Babies require plenty of ‘tummy time’ so that they can strengthen their neck muscles and ensure proper skull development.

If required and torticollis is a cause of the plagiocephaly, physical therapy can help reduce the chance of flat head syndrome.

In more severe cases a plagiocephaly helmet may be of use, this supports the baby’s skull and aids in reshaping the skull by fitting loosely around the flatter parts of the skull.¹ 

Beyond childhood, the only way to correct plagiocephaly is through surgery, however this is usually not a viable procedure, with plagiocephaly in adulthood being purely cosmetic and having no greater impact on health, no intervention is recommended or required.⁹ 

Summary

Plagiocephaly is the flattening of part of the skull, this occurs during infancy; whilst the skull is still soft. This can be prevented by changing the sleeping position of a baby so that there isn’t too much pressure on just one part of the skull; as this is what leads to the formation of flat spots, and therefore ‘flat head syndrome’.

Although skull abnormalities may be carried into adulthood, this causes no further issues in terms of overall health and is purely cosmetic, therefore intervention is not recommended.