Plagiocephaly Vs. Brachycephaly: The Key Differences

When it comes to your baby’s head shape, understanding the differences between plagiocephaly and brachycephaly can help you make informed decisions about prevention, diagnosis, and treatment. While both are types of positional cranial deformities, each condition has distinct characteristics, causes, and treatment approaches.

In this blog, we’ll break down the key differences between plagiocephaly and brachycephaly to help you understand what’s best for your baby.

[plā-jē-ō-sef-uh-lee] Plagiocephaly is a cranial condition where one side of the back of an infant’s head becomes flattened. It’s caused by external pressure applied to the soft and malleable skull, typically during the first few months of life.

What It May Look Like

• A flat spot on one side of the back of the head.

• Misaligned ears, with one ear appearing further forward than the other.

• Asymmetry in facial features, such as a slanted forehead or uneven cheekbones.

Plagiocephaly impacts the symmetry and shape of your baby’s head and face, and in severe cases, it may lead to challenges such as difficulty fitting helmets for sports or work, glasses, or other essential gear. These imbalances may also affect jaw alignment, potentially causing challenges with chewing, starting solids, or overall facial balance. Taking early action supports proper head shape development, helping to prevent these issues as your baby grows.

Brachycephaly [brae·kuh·seh·fuh·lee] is a condition in which the back of a baby’s head becomes flattened, leading to a wider appearance. Unlike other head shape deformities, such as plagiocephaly (which causes one side of the head to flatten), brachycephaly affects the back of the skull, causing it to flatten and widen. Parents often notice this condition shortly after birth, particularly if the baby spends extended time lying on their back.

Key Characteristics

• Flattening across the back of the head.

• A wider-than-average head shape with less pronounced occipital bone development (the back of the skull).

• The head appears shorter from front to back.

While both conditions involve changes to a baby’s head shape, plagiocephaly and brachycephaly differ in their appearance, causes, and treatment approaches. Below is a detailed comparison:

Aspect	Plagiocephaly	Brachycephaly
Positioning	Flattening primarily affects one side of the back of the head, often accompanied by asymmetry in the forehead and facial features.	Flattening occurs across the entire back of the head, resulting in a wider and shorter head shape.
Causes	Often linked to positional preferences or torticollis, where babies favor one side of their head.	Typically caused by prolonged time in reclined devices, reduced tummy time, or a sleeping position where the baby consistently looks straight up at the ceiling, all of which apply pressure evenly across the back of the head.
Facial Features	May cause facial asymmetry, such as uneven cheekbones, a slanted forehead, or misaligned ears.	It may cause changes to overall head width, ear alignment, and in some cases, facial features may appear closer together in the centre of the face.
Diagnosis	Focuses on asymmetry and the angle of flattening.	Involves measuring the head’s width-to-length ratio to determine its shape.
Treatment	Repositioning techniques, such as alternating sleep directions and increasing tummy time, may be effective in early infancy for mild cases. Cranial remodelling orthoses (CRO), like the ROKband, are typically recommended for moderate to severe cases, particularly when repositioning techniques have been unsuccessful. Treatment is most effective when initiated between 4-6 months of age but can still provide significant results up to 18 months.	Encouraging active play and limiting time in reclined devices can be effective for preventing further flattening in mild cases, especially when started early, typically before 4 months of age. For moderate to severe cases, or when repositioning measures have not shown improvement, CRO treatment is recommended. ROKband, a custom-designed cranial remodelling orthosis, works by redirecting growth to the back of the head to restore length. Treatment is most effective when initiated between 4-6 months of age but can still provide significant results up to 18 months.

Early intervention is crucial for both plagiocephaly and brachycephaly. During the first year of life, a baby’s skull is most responsive to treatment due to its rapid growth and malleability.

Key Points to Remember:

• Before 4 Months: During the first four months of life, a baby’s skull is highly malleable, making repositioning techniques and tummy time most effective for preventing or correcting mild flattening. If you notice a flat spot during this critical period, early intervention with repositioning and guidance from pediatric health professionals can often help improve the concern or prevent it from worsening.

• 4 to 6 Months: If your baby is 4 months or older and you are not seeing continued progress and still have concerns, we recommend scheduling a free head shape assessment at ROKband. At this age, cranial remodelling orthoses (CRO), like the ROKband, are particularly effective because the skull is growing rapidly and we are able to redirect new growth to the desirable areas in order to create symmetry. 

• Up to 18 Months: We can assess and treat from 4 months up to 18 months, with early treatment offering the best chance for optimal results.

Choosing the Right Treatment

At ROKband, we are committed to providing innovative, comfortable, and expert care that ensures the best outcomes for your baby. Here’s what makes our CRO designs unique:

• Advanced 3D Scanning Technology: We use precise 3D, LED light scanning technology to capture precise measurements of your baby's head shape, ensuring that each CRO is custom-designed to deliver optimal results. 

• Tailored Design: Every ROKband CRO is custom-designed using specialized CAD/CAM technology to fit each baby’s unique head shape. Our orthotists take the time to review every scan and design each ROKband to ensure the fit is both corrective and comfortable.

• Lightweight Materials: Our CROs are made with hypoallergenic materials designed for comfort. ROKbands are 1/2 the weight and 1/3 the thickness of other helmets so babies can participate in daily activities without being hindered by a bulky helmet.

• Breathable: ROKbands have been engineered with increased ventilation to make them as much as 4 degrees cooler. This minimizes the discomfort of sweating, skin irritation, and unwanted odours.

• Aesthetic Choices: We offer a variety of fun, customized and colorful designs to make the experience enjoyable for both babies and parents.

Conclusion: Understanding the difference

Recognizing the differences between plagiocephaly and brachycephaly can help you take the right steps toward early intervention and effective treatment. Whether your baby’s head shows signs of asymmetry or a broader shape, proactive measures like repositioning, tummy time, and cranial remodelling orthoses can make a significant difference.

If you’re unsure about your baby’s head shape, schedule a free head shape assessment today to learn more about your options. Early action ensures the best results and sets the foundation for a healthy, happy future for your little one.