The American Academy of Pediatrics (AAP) recommends that infants sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS) and other sleep-related deaths. As a result, pediatricians have seen an increase in the number of children with positional plagiocephaly, or positional skull deformities (flat heads).
In the revised AAP clinical report, “Prevention and Management of Positional Skull Deformities in Infants,” in the December 2011 Pediatrics (published online Nov. 28), positional skull deformities are commonly diagnosed as benign, reversible head-shape irregularities that are caused in utero or may develop during the first few months of life, and do not require surgical correction.
It is important for pediatricians to be able to differentiate between infants with positional skull deformities and infants with craniosynostosis, a more serious condition that can lead to neurological damage or severe craniofacial deformity. The vast majority of positional plagiocephaly cases can be corrected with physical therapy and noninvasive measures. Helmet therapy is rarely necessary.
If the condition appears to be worsening by 6 months, referrals should be made to pediatric neurosurgeons with expertise in caring for this condition to help determine whether a skull-shaping helmet or other interventions are needed.