The Difference Between Plagiocephaly and Brachycephaly

Flat Head Syndrome is a name often used to describe plagiocephaly and brachycephaly, and less likely, scaphocephaly. These conditions are not the same however, and the way that they will affect your child’s appearance and development also vary. In this article, we’ll help you understand the differences between plagiocephaly and brachycephaly.

Positional plagiocephaly is a condition which results from a child frequently being placed to sleep on their backs, without repositioning of the skull. For example, if your son or daughter prefers to sleep with their head facing left or right and does not ever sleep facing the other direction they may be at risk of developing plagiocephaly. Of course, it can be difficult to understand how this differs from brachycephaly. Brachycephaly, however, often results from a child facing up while they sleep, and not ever facing left or right. Some children develop a mix of the two deformities, making diagnosis more difficult.

The primary means of differentiation and diagnosis of these two conditions is conducted using a series of skull measurements. For plagiocephaly, a relatively reliable measurement involves the use of a craniometer to determine the level of skull asymmetry present. Brachycephaly is measured using a different set of measurements called the cephalic index, or cephalic ratio. Unfortunately, the reliability of cephalic index measures has been widely questioned, and over ten different diagnostic measurements have been proposed since 1979.

Plagiocephaly is thought to potentially cause developmental delays including gross motor skills delays, or at least to be related to these delays in many cases. Brachycephaly that goes untreated has been tied to the presence of sleep apnea in recent years. Both conditions are thought to be related to TMJ, vision, and hearing problems when left untreated.

Children with lambdoid synostosis may be misdiagnosed as having positional plagiocephaly, since the two conditions appear similar externally. In positional plagiocephaly however, the cranial sutures have not closed early. The affected area of the skull takes on a flattened appearance, and surrounding bones and structures bend to accommodate the altered cranial form. Usually, this flat spot occurs on the side-rear of either the left or right of a baby’s skull. One ear may stick out, and your child’s facial features may change as a result of moderate to severe plagiocephaly. Many children with positional plagiocephaly also have muscular torticollis. The exact relationship between the two diagnoses may vary – in some cases muscular torticollis may be the cause of plagiocephaly, while in others it may result from the condition.

Positional brachycephaly differs from plagiocephaly due to the location on the skull which it affects. This condition causes a nearly symmetrical flattening of the rear of a child’s skull, often leading to an exaggerated height in the rear of the skull and perhaps to an altered forehead shape, as well. Your baby’s ears may stick out on both sides if he or she has brachycephaly, and their face may be wider than normal as well.

Plagiocephaly and brachycephaly can both be corrected. The primary techniques used to help a child regain normal head shape from these conditions include physical therapy and repositioning for minor cases, and the use of helmet or band therapy for more severe incidents of plagiocephaly and brachycephaly. If your child has been diagnosed with either of these conditions, first ask the treating physician about the severity of their particular case, and then inquire about recommended treatment options. While the ramifications of these conditions in the long term are still unclear and there is debate as to what types of treatment are most effective, early intervention is crucial to therapeutic and orthotic success.