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What is plagiocephaly?
Plagiocephaly (play-gee-oh-kef-a-lee) is a condition where a baby’s head is flat on one side. It causes the head to appear misshapen or uneven. Plagiocephaly is common and does not affect brain growth. If left untreated, it may change a baby’s
physical appearance by causing their face and head to grow unevenly.
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Figure one: Medical illustration demonstrating plagiocephaly.
What is brachycephaly?
Brachycephaly (bray-key-kef-a-lee) is where the back of a baby’s head is flat. Like plagiocephaly, brachycephaly does not affect brain growth. However, it may change a baby’s physical appearance. In some cases, the forehead may also bulge out and the
face may widen.
Figure two: Medical illustration demonstrating brachycephaly.
What causes plagiocephaly and brachycephaly?
There are many reasons why a baby may develop plagiocephaly or brachycephaly. Some babies are born with a misshapen head because of their position in the womb during pregnancy, while others develop a misshapen head after birth. A baby’s head may change
shape during labour due to pressure; this could be caused by the size of the birth canal, or instruments used during delivery. This is called moulding, and it often resolves quickly.
A newborn’s skull bones are very soft, so the head can easily change shape. If a baby prefers one side or lies with their head in the same position for a long time, the position of the ears, forehead and face may change.
Babies could also develop a misshapen head if they:
- look in one direction more than the other
- feed on one side more than the other
- are carried on one side more than the other
- have tight or stiff neck muscles (torticollis) and struggle to turn their head
- cannot move due to health or medical conditions.
Craniosynostosis is another misshapen head condition where the skull bones close abnormally. You can learn more about craniosynostosis through the link at the bottom of this page.
How to prevent plagiocephaly and brachycephaly
A baby's head position should change while they are awake and asleep to prevent plagiocephaly and brachycephaly.
- Sleeping position: Always place your baby on their back to sleep to reduce the risk of sudden infant death syndrome (SIDS) – also known as Cot Death. Do not use pillows in the cot for positioning. For more information on safe sleeping, visit
the Red Nose website linked at the bottom of this page.
- Head and cot position for
sleep: A young baby will generally stay in the position they are placed in for sleep until they can move themselves. Alternate your baby’s head position when you place them down to sleep. You may like to place your baby at different ends of the
cot or move the cot to another spot in the room. Babies like to look at objects – such as windows, paintings or people – so changing their cot position will encourage them to look at things that interest them from multiple angles.
- Playtime: When your baby is awake, play with them on their side, lying on their front (tummy time) or facing you (face-to-face time). You can do this as early as one or two weeks
of age. Place rattles, toys or other people’s faces in different positions to encourage your baby to turn their head both ways. From a young age, most babies can follow voices or eyes and turn their heads each way while alert when you support
their head.
- Holding and feeding positions: Vary your baby’s position throughout the day to avoid them spending too much time on their back. You can use a sling, hold them upright for cuddles or carry them over your arm on their tummy or side. If you breastfeed
your baby, try to alternate feeding sides. If you bottle feed your baby, feed them from both directions and swap sides regularly – even if one side feels less natural.
When to see a doctor about misshapen head
If you have concerns about your baby's head shape or notice your baby only turns their head to one side when lying on their back, see your Maternal Child Health Nurse, a children’s physiotherapist or a doctor.
Treatment for plagiocephaly and brachycephaly
Most babies with a misshapen head do not need any treatment – especially if they are active and have plenty of one-on-one interaction. Plagiocephaly and brachycephaly usually improve as your baby grows and starts to move their head by themselves.
Try to encourage your baby to turn their head when they are awake. From a young age, most babies can follow eyes or voices when you support their head. At first, one side may seem harder for your baby than the other; this is normal. The more you practice
the harder way, the easier it should get.
If your baby needs treatment for a misshapen head, a doctor may refer you to a specialist clinic. This may include sessions with a paediatrician, children’s physiotherapist and orthotist.
Children’s physiotherapists often treat babies with misshapen heads by encouraging active movement. They also teach parents how to position their babies and complete exercises to improve their head shape.
A very small number of babies with plagiocephaly and brachycephaly have a severe and persistent deformity and may need helmet therapy.
Helmet therapy
Most babies do not need helmet therapy. However, a specialist may suggest it if your baby's head is severely and persistently misshapen at six months of age.
If your baby meets the criteria for helmet therapy, an orthotist will make a lightweight, custom helmet for them using 3D images of the head. The helmet helps to reshape the skull by taking pressure off the flat area, allowing the skull to grow into the
space provided.
Helmet therapy is most effective if started between six and eight months of age and is completed before 12 months, as this is when the skull grows rapidly.
Please read the sheet linked at the bottom of this page to learn more about helmet therapy and how to care for a child undergoing it.
Misshapen head and neck tightness videos
These videos will help you understand and manage your baby’s head shape and neck tightness.
What is plagiocephaly (misshapen head)?
Learn more about plagiocephaly and who you can speak with to get advice for your baby.
Treating misshapen head
Learn about the causes of a misshapen head and how you can prevent this from happening or help your baby if they are already experiencing it.
Treating left neck tightness (left torticollis)
Watch this video if your baby needs to practice turning their head to the left side and moving their right ear to their right shoulder.
Treating right neck tightness (right torticollis)
Watch this video if your baby needs to practice turning their head to the right side and moving their left ear to their left shoulder.
Key points to remember
- Plagiocephaly and brachycephaly are common conditions where a baby’s head is misshapen.
- Some babies are born with a misshapen head; others develop a misshapen head after birth.
- Plagiocephaly and brachycephaly may change a baby’s physical appearance, but they do not affect brain growth.
- To prevent or help a misshapen head during sleep, lie your baby on its back and alternate its head position. Do not use pillows in the cot.
- Vary your baby’s position when awake and alert, including when they play and feed.
- If you are worried about your baby's head shape, talk to your maternal-child health nurse, children's physiotherapist, or a doctor.
- Plagiocephaly usually improves without treatment if your baby is active and has lots of one-on-one interaction.
Common questions about plagiocephaly and brachycephaly
Should I change my baby’s head position while they sleep at night?
This is not necessary. Young babies will remain in the position you leave them in. Older children who can move around should be left to sleep because they will likely return to their preferred position once you leave the room.
Can plagiocephaly be corrected?
Plagiocephaly will often correct itself with the above positioning and play advice as your baby grows. A very small number of babies will need helmet therapy to correct a severe and persistent misshapen head.
Does a misshapen head hurt a baby?
A mishappen head is not painful for babies and should not impact their ability to play and develop.
My baby has torticollis; will it develop a misshapen head?
A baby with a stiff and tight neck – called torticollis – may struggle to turn its head and favour one position. This lack of movement can cause a misshapen head, but it may be avoidable when managed early. If your baby is diagnosed with torticollis,
speak to a children’s physiotherapist about how you can best manage their condition.
For more information
Developed by The Royal Children’s Hospital Physiotherapy department, with advice from General Medicine, Orthotic and Prosthetics and Plastics and Maxillofacial Surgery. We acknowledge the input of RCH consumers and carers.
Reviewed September 2024
Please always seek the most recent advice from a registered and practising clinician.