Healthy Kids    

How to prevent plagiocephaly

Detecting it early can prevent skull misshaping

Ching-Rong Tsai, MD, a Monticello pediatrician, explains that the fontanels or soft spots on a baby’s skull will close over time, making a child’s head less malleable. The occipital fontanel, found at the base of the skull, will generally close when a baby is between 3 and 5 months. The frontal fontanel, found at the very top of the baby’s head, will start to close when a child is 12 to 18 months

Because a child’s head is so malleable in the first few months of life, Tsai stresses the need for parents to lay their children down differently each time they take a nap. For example, during a morning nap, allow the child’s head to fall to the right. During an afternoon nap, let it fall to the left. Give the infant objects to look at to encourage him to look in the desired direction.

“Babies like to look at some-thing bright,” he explains. “If you have a window, they’ll turn their head to look at it, or if you have a mobile on the ceiling, they’ll stare up at it.”

Although he agrees wholeheartedly with the Back to Sleep method to prevent SIDS, varying placement in the crib will encourage the child to turn the head different ways to get a glimpse of a brightly-colored toy or the scene outside the window. If you start to notice a slight flat spot, be more consistent about changing your baby’s position, Tsai says.

“The head will start to get better,” he explains. “I also encourage the baby to do tummy time.”

Dr. David Fenner of the Children's Medical Group, agrees. “Keep the baby off his back as much as possible. Carry your baby when you can. That’s why carriers like Baby Bjorn and Snuglis are great. Besides, babies like to be held.”

Supervised periods off of their backs reduce that constant pressure on the delicate fontanels. Tummy time also gives babies the opportunity to work on their muscle control – especially those neck muscles

that allow them to begin moving their heads.

“Flattening can be detected as early as a month of age, and I make the parents aware of it,” says Dr. Fenner. “If you have concerns, talk to your pediatrician.

“[Flattening] can be prevented by finding it early and positioning the child so that the weight is not always on the head,” he advises.

An American Academy of Pediatrics report showed the children diagnosed with plagiocephaly because of too much time spent on their backs “are also more likely not to have had the head position varied when put down to sleep, more likely to have had less than five minutes per day of tummy time, and less likely to have been held in the upright position when not sleeping.”

For parents who have followed all the steps and find their children still need intervention, orthotist George Tanner of Monroe Orthotics & Prosthetics has encouraging words. “They do fine,” he notes. “Parents I think are traumatized more than the kids!”


Jeanne Sager is a writer and mom from Callicoon Center. Visit her at