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Positional Skull Deformities and Torticollis

The medical term for positional skull deformities is occipital plagiocephaly. The formal definition of occipital plagiocephaly is “oblique head.” When viewed from above, the head has a parallelogram appearance caused by constant pressure to the back of one side of baby’s head. Occipital plagiocephaly also results from prolonged positioning on the back of the head, causing it to flatten unevenly across the back, thus resulting in an altered head shape. The height of the back of the head may also be high.

What’s the Cause?

These conditions occur because a baby’s skull bone, as noted earlier, is extremely soft and flexible. The soft skull allows for the impressive brain growth that occurs during a baby’s first year of life. Yet when a baby stays in one position for too long, pressure prevents the skull from developing a normal shape. Unfortunately, some babies show a preference for sleeping or sitting with their head turned in one direction most of the time, which can be because of tightness of the muscles on one side of the neck. Whatever the reason, when the head is constantly turned to one side or stays in the center, the consistent pressure molds a flat spot into the skull. This can occur quickly within the first 2 months or more gradually over 3 to 6 months.

Additional factors associated with positional skull deformities:

  • Being firstborn
  • Prematurity
  • Limited exposure to tummy time
  • Not altering baby’s head position during sleep


About 85% of babies diagnosed with torticollis or tight neck muscles also have plagiocephaly. If a baby experiences intrauterine constraint, he may be born with torticollis. In this condition, the neck muscles shorten on one side, causing baby’s neck to turn in a twisted position, tilting his head to one side with his chin often pointing to the other side. It contributes to positional skull deformities because the baby’s head tends to always be turned in the same direction, thus causing pressure against the same side.


Torticollis can be treated with stretching exercises from a physical or occupational therapist along with a home program administered by parents.

If you suspect your baby has torticollis, consult with your child’s pediatrician immediately. By the same token, if your baby only sleeps with his head in midline, he is at risk for plagiocephaly, which can lead to future problems with fitting into safety helmets for sports or work. If you see your baby doing this, please discuss it with your pediatrician.

Ways to Prevent Occipital Plagiocephaly

  • Put baby to sleep on a firm, flat surface (on his back).
  • Alternate your baby’s head position by frequently placing him down for sleep at opposite ends of the crib. Occasionally change positions of the crib.
  • Move the mobile to different ends of the crib.
  • Alternate arms when holding and feeding your baby.
  • Encourage supervised tummy time and side lying when baby is awake and supervised.
  • Greatly limit the time your baby spends sitting in carriers and swings.
  • If you notice your child consistently resists turning his neck to one side, consult with your child’s pediatrician.

Additional Information

Anne H. Zachry, PhD, OTR/L
Last Updated
Retro Baby (Copyright © 2013 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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