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Plagiocephaly and Craniosynostosis

Checked: 05-01-2023 by Vicky Ryan Next Review: 03-01-2025



Positional plagiocephaly is a condition characterised by changes in skull shape and symmetry in infants who are older than 6 weeks of age. It results from mechanical factors which when applied over time in utero, at birth or post- natal, alter the shape of the skull. There has been a significant increase in the incidence since the “Back to Sleep” campaign 1992.

History and physical examination are usually sufficient to make a diagnosis.

Please see the clinical guidance on Plagiocephaly provided by Bristol Royal Hospital for Children, for further details.

Craniosynostosis (premature fusion of sutures)

Clinicians should consider craniosynostosis, the premature fusion of cranial sutures in a child, as a possible diagnosis when reviewing babies with concerns about head shape. This condition has a global prevalence of approximately one in 1695 live births (1).

Although less common than positional plagiocephaly, it is vital to identify these babies as they need rapid referral and may require surgery. 

Differences seen in Craniosynostosis compared to positional Plagiocephaly:

  • Occipital flattening already at time of birth
  • Lambdoid suture has palpable ridge
  • Ear on flattened side is typically posterior and inferior to the other ear (whereas in plagiocephaly the ear on the flattened side is 'pushed forward')
  • Frontal asymmetry is less

Typical unilateral occipital flattening can usually be managed by counter positioning and providing parents with the patient leaflet.

More severe cases (especially if possible cranial syntosis or associated developmental delay) should be referred to general paediatrics or physiotherapy in the first instance. Where there is severe positional plagiocephaly +/- unresponsive to conservative measures, these may be referred for a neurosurgical opinion via e-referral (or phone Paediatric Neurosurgery on 0117 342 8585/8584 for advice).  

Refer to the clinical guidance on Plagiocephaly provided by Bristol Royal Hospital for Children, for further details.



(1) Recognising a child with isolated craniosynostosis | The BMJ

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