Position of the ear in deformational plagiocephaly differs from that seen in craniosynostotic plagiocephaly where the ear may be raised up and anteriorly placed. This feature is most obviously noticed from above looking down on the top of the head. There are other more subtle characteristics which may not be as noticeable on first glance but which have been used to distinguish this sequence from plagiocephaly due to craniosynostosis. Other deformations such as dislocation of the hips and positional club foot are also frequently associated findings due to late gestational constraint, especially if the baby was caught in breech presentation. Some feel that ischemia or scarring to the muscle may be the cause for the torticollis.
Initial management involves a period of observation for spontaneous resolution.
This may be accomplished with the use of a sandbag or pillow propped behind the baby or by placing toys and other stimulating objects in the infant's preferred field of view. By training the child not to lie on the already flat parts of the head,this will allow those areas to fill out. Management for infants who do not make progress with exercises alone, or for infants with moderate to severe plagiocephaly still present at age 6 months involves the use of a corrective helmet. Helmet therapy is designed to re-mold the infant's head to a more normal, symmetric oval shape. The helmet is custom fit by taking a mold of the infant's head, creating a bust from this mold and reshaping it by adding plaster material to the flattened areas to create a symmetric head shape and form a template for the helmet.