Plagiocephaly is a term derived from the Greek (plagios– “twisted” and kephale– “head”) and describes an asymmetric head shape. The potential causes of cranial asymmetry are multiple and the most important aspect in assessing any child with plagiocephaly is the need to exclude the possibility of craniosynostosis. Craniosynostosis is the premature fusion of one or more skull sutures and often leads to altered head shape; there may also be an associated intracranial hypertension and developmental delay. Premature closure may occur in a single suture or in multiple sutures, as is more commonly seen in syndromic craniosynostotic conditions such as Crouzon or Apert syndromes. Treatment involves assessment, multidisciplinary input from psychologists and speech therapists, and surgery. Positional or deformational plagiocephaly usually presents as occipital flattening present in the peri-natal period, either as a unilateral or bilateral deformity and may be associated with changes to the anterior craniofacial skeleton.1 The purpose of this article is to summarise current concepts in the management of positional plagiocephaly and to highlight the present controversy concerning management of the condition with helmet therapy.

AETIOLOGY

Positional plagiocephaly is the most common type of cranial asymmetry, with a prevalence ranging from 5% to 48% in healthy newborns.2 It is distinct from the cranial moulding associated with childbirth, which usually resolves spontaneously in the first weeks of life. Positional plagiocephaly, by contrast, tends to be a post-natal condition which arises due to external forces acting on a flexible cranial skeleton. The worldwide increase in the presentation of positional plagiocephaly has been linked to the various paediatric “Back to Sleep” campaigns, which have recommended that infants be placed supine, to reduce the risk of sudden infant death syndrome (SIDS).3 The incidence of SIDS has been reduced by up to 40%, but at the same time a significant increase …