Positional Plagiocephaly For more information, please visit our Pediatric Neurosurgery Program site What is it? Childs head is flattened at the back causing the skull to be slightly elliptical in shape. His is also known as positional molding or lazy lambdoid. What causes it? At birth a baby’s skull is made up of many small bones. Between each bone section are sites know as “sutures”. The most noticeable suture is the Anterior Fontanel or “soft spot”. This is the area where four smaller bones meet. There is also a spot at the back of the head called the posterior fontanel. As the brain grows the sutures allow for rapid expansion of the skull. It is the growth of the brain that determines head size and shape. If the brain is forced to grow in a different direction the skull will assume a different shape. Several years ago pediatricians recommended infants sleep on their sides or backs to prevent SIDS (sudden infant death syndrome). Since then there has been an increase in positional molding cases. The lambdoid suture area is usually affected. As the brain grows forward the infant will develop a bulging forehead and forward displacement of the ear on the same side as the flattened area. Infants with torticollis (twisted neck) may also develop plagiocephaly. Infants with this condition have a noticeable head tilt and neck stiffness due to shortened neck muscles on one side. What is the treatment? In mild cases positioning the child off the affected side is recommended. When the child is awake, he/she may be placed on their stomach, or laying on the unaffected side with a small pillow behind the back. Limit the time a child spends in a carrier. In severe cases a child may need a helmet to help mold the head into a more normal shape. The helmet will need to be worn 24 hours a day for several months. If the child has torticollis they may require physical therapy to help stretch the affected muscles. A lopsided head does not harm your baby’s brain. In extreme cases it can lead to facial deformities if untreated.