Positional plagiocephaly

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RepositioningChoose any

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Counseling

Flattening from position is common, does not affect brain growth, and usually improves as babies sit up and move more. Recommended supportive care with an emphasis on tummy time several times a day while awake, alternating the direction the baby faces in the crib, and less time in car seats and swings. Always place the baby to sleep on the back. Return precautions given including worsening head shape, a hard ridge along the head, trouble turning the head, developmental concerns, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

A specialist will check whether one of the skull seams closed early, which can need treatment. Keep tummy time and back sleeping as usual until then. Return precautions given including vomiting, unusual sleepiness, a bulging soft spot, developmental concerns, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Positional plagiocephaly
• Parallelogram head shape with the ear forward on the flat side, consistent with positional flattening
• Head circumference tracking normally
• Full neck range of motion
• Recommended supervised tummy time while awake, alternating head direction at sleep, and limiting time in car seats and swings, while always sleeping on the back on a flat surface
• Follow up in 1-2 months to recheck head shape

Flattening from position is common, does not affect brain growth, and usually improves as babies sit up and move more. Recommended supportive care with an emphasis on tummy time several times a day while awake, alternating the direction the baby faces in the crib, and less time in car seats and swings. Always place the baby to sleep on the back. Return precautions given including worsening head shape, a hard ridge along the head, trouble turning the head, developmental concerns, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Plagiocephaly, brachycephaly, craniosynostosis (title)
Exam: parallelogram vs ridge
Repositioning; safe sleep
PT; helmet before 12 months; craniofacial; imaging

Return precautions in the template

worsening head shapea hard ridge along the headtrouble turning the headdevelopmental concerns

Sources

AAP Clinical Practice Guideline for Diagnosis and Management of Faltering Weight. Pediatrics 2026;157(4):e2025075764
AAP Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics 2022;150(1):e2022057988. Recommendations read
Thomas J et al; AAP Section on Breastfeeding. Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report. Pediatrics…
Shaw BA, Segal LS; AAP Section on Orthopaedics. Evaluation and Referral for Developmental Dysplasia of the Hip in Infants. Pediatrics 2016;138(6):e20163107.…
Krowchuk DP et al. Clinical Practice Guideline for the Management of Infantile Hemangiomas. Pediatrics 2019;143(1):e20183475. Highlights and selected KAS read
AAP Clinical Report: Prevention and Management of Positional Skull Deformities in Infants (Laughlin, Pediatrics 2011;128(6):1236). Retired February 2018 (not…