Positional Plagiocephaly describes a condition in which a baby’s skull is flattened on one side of the back or front of the head. Plagiocephaly can be congenital (present at birth) or develop during infancy (positional or deformational) due to repeated pressure on one part of the head.

In 1994, the American Academy of Pediatrics introduced the Safe to Sleep Campaign that was aimed to educate caregivers and parents on ways to reduce the incidence of Sudden Infant Death Syndrome (SIDS). Central to this campaign was to have infants sleep on their backs on a stiff mattress. Subsequently, in the last 25+ years, the incidence of SIDS has significantly dropped. However, an unintended consequence has been a dramatic increase in positional Plagiocephaly.. This is due to the fact that babies’ heads are soft and malleable, and sleeping on a stiff mattress can cause misshaping of the skull. This condition is even more prevalent in premature infants whose skulls are especially pliable.

All babies are at some risk for positional plagiocephaly. Up to 1 in 4 babies has noticeable head deformation from positional plagiocephaly. However, babies may be more likely to have this condition if they are:

• a first-born child
• male
• born with the help of instruments.
• born prematurely

Mild positional plagiocephaly does not usually cause serious complications. However, if positional plagiocephaly develops and is not treated early enough, then the baby's head may continue to be uneven. New studies are also showing a significant correlation between positional plagiocephaly and cognitive development. School-aged children with moderate to severe positional plagiocephaly had lower scores on cognitive and academic measures. If congenital plagiocephaly is left untreated, it can lead to serious complications, including:

• Head deformities, possibly severe and permanent
• Increased pressure inside the head
• Seizures
• Developmental delay

If your baby has a misshapen head, your pediatrician will need to determine whether it is caused by sleep position or is congenital. With a physical exam, the physician will determine the severity of the condition and create a treatment plan.