Positional plagiocephaly is the flattening of an infant's skull caused by a recurring position. Its prevalence has risen sharply since the recommendation to place babies on their backs to sleep (to help prevent sudden infant death syndrome). It is now one of the leading reasons for consultation in paediatric osteopathy.

Positional plagiocephaly or craniosynostosis?

First of all, it's important to distinguish between two very different situations:

✓Positional (or deformational) plagiocephaly: benign, caused by repeated external pressure on a still-malleable skull. This is the most common case — treatable with osteopathy, physiotherapy and adapted positioning.
✓Craniosynostosis: premature fusion of one or more cranial sutures. This is a surgical condition requiring neurosurgical care. Osteopathy is NOT indicated without prior medical advice.

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Prior medical consultation recommended

Before seeing an osteopath for a skull deformity, a paediatric assessment is recommended to rule out craniosynostosis. If in doubt, your paediatrician or GP can guide you.

Types of positional skull deformity

✓Plagiocephaly: asymmetric flattening, often on one side (left or right occipital). The ear on the flattened side is often pushed forward, and the forehead on that side may be slightly more prominent.
✓Brachycephaly: symmetrical flattening of the back of the skull, giving a wide, short-looking head.
✓Positional scaphocephaly: a long, narrow head shape (less common).

Causes and risk factors

✓Congenital or functional torticollis: the baby shows a preferential head rotation, often linked to muscle tension (SCM muscle) that developed during pregnancy or birth
✓Assisted delivery (forceps, vacuum extraction) or a prolonged labour: compression and cranial tension at birth
✓Breech or transverse presentation: asymmetric pressure in utero
✓Consistently lying on the back without varying positioning
✓Prematurity: a more malleable skull, prolonged time lying down

Signs to watch for from the first weeks

✓Baby always turns their head to the same side (even while sleeping)
✓Visible flattening on one side of the back of the head
✓Ear asymmetry (one ear more forward than the other)
✓Slight forehead prominence on the flattened side
✓Visible neck tension (tighter muscles on one side)

Why timing matters

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Before 4 months: act quickly

An infant's skull is made of bones that are still very malleable, separated by flexible sutures. Between 0 and 4 months, cranial plasticity is at its peak — the ideal window for osteopathy. After 6 months, the bones gradually stiffen and correction takes longer. After 12-18 months, a remodelling helmet may be needed in severe cases.

What the osteopath does

The session takes place entirely on the table, using extremely gentle techniques — the baby can be asleep or awake. The osteopath:

✓Assesses cranial mobility and identifies the least mobile sutures (occipital, temporal, parietal)
✓Releases muscular and ligamentous tension in the neck, particularly the SCM (sternocleidomastoid) muscle if torticollis is present
✓Works on sacral mobility and the lower limbs (dural connections between skull and sacrum)
✓Gives advice on baby-carrying and positioning to vary pressure points day to day

Results and number of sessions

When treatment begins early (before 4 months), 2 to 4 sessions spaced 3 to 4 weeks apart generally give very good results. Parents often notice an improvement in head rotation from the very first session. Visible correction of the skull shape follows gradually over several weeks.

For cases diagnosed later (4-8 months), follow-up takes a little longer (4 to 6 sessions), but results are still often satisfactory. Beyond this, a specialist opinion may be needed.

FAQ

Can plagiocephaly correct itself?+

Mild forms can improve spontaneously with varied positioning. For moderate to severe forms, active care (osteopathy + positioning) significantly speeds up and improves correction. Without intervention, moderate deformities can persist and, in severe cases, a helmet may be needed.

Do I have to choose between osteopathy and physiotherapy?+

These two approaches are complementary, not competing. Physiotherapy is particularly indicated when there is true muscular torticollis (SCM tightness). Osteopathy addresses overall cranial, joint and myofascial tension. Both can be pursued at the same time.

My baby is 6 months old and I've just discovered plagiocephaly — is it too late?+

No. Even after 4 months, osteopathy remains useful for improving neck and cranial mobility. Spontaneous correction is slower but still possible. You simply need to adjust expectations and possibly consider a specialist assessment if the deformity is pronounced.

How many sessions are needed for plagiocephaly?+

On average, 3 to 5 sessions for cases seen before 4 months. A follow-up check at 3 months is often advised. For later or more severe cases, the protocol is adapted individually.

Are there long-term consequences of plagiocephaly?+

Mild to moderate forms have no demonstrated neurological impact. A severe untreated deformity, however, can affect maxillofacial development, dental occlusion and, more rarely, vision. This is another reason not to wait.

Positional Flat Head Syndrome: Can Osteopathy Help Your Baby?