Cranial Asymmetry 101

Cranial asymmetry can be caused by many factors. Babies’ heads are made of free-floating bony plates that allow the brain to grow, so even slightly prolonged pressure can lead to the development of flat spots. ​

Any of the following may also increase the risk of asymmetry or disproportion:

  • Premature birth
  • Congenital muscular torticollis
  • Multiple births
  • Restrictive intrauterine positioning
  • Trauma at birth
  • Cervical spine abnormalities
  • Favoring one side over another, which may be a sign of torticollis

​​​​Three Basic Head Shapes

There are three common asymmetrical head shapes, which are easiest to see from the top looking down. If you don’t recognize your baby’s head shape below, consult your Hanger Clinic orthotist. Subtle differences are possible within each of these broad categories.

Plagiocephaly sketch


Plagiocephaly (play-jee-oh-sef-uh-lee) can usually be identified by flattening on one side of the back of the head, and one eye or ear may appear higher than the other.​

  • Forehead protrudes slightly on one side
  • Back of the head flattened on one side
  • Sometimes referred to as a parallelogram shape because it looks like one side of the baby’s head has been pushed forward
  • Eyes and ears may be misaligned


Brachycephaly (brake-ee-sef-uh-lee) generally appears as flattening across the back of the head with a prominent forehead, and the height of the baby’s head may appear taller.​

  • Back of head appears wider and uniformly flatter
  • Height of the baby’s head looks taller than normal
Scaphocephaly Sketch


Scaphocephaly (skaf-uh-sef-uh-lee) is typically observed as a long, narrow head shape.

  • Commonly seen with premature babies who spent time in a NICU or consistently rest on either side of the head
  • Elongated shape from front to back and narrow from side to side


What is Torticollis?

Congenital muscular torticollis (CMT) is a tilting and/or turning of a baby’s neck to one side as a result of a muscle strain to the sternocleidomastoid (SCM) muscle that runs along the side of the neck from your clavicle to the back of your ear. When this muscle becomes tight or weakened, your baby’s head tilts to one side and/or turns to the opposite side. CMT is seen in approximately one in 250 babies.

Torticollis can cause or worsen plagiocephaly and requires separate physical therapy treatment. Talk to your doctor if you think your child may have CMT.

Learn more about torticollis (PDF)

What is Craniosynostosis?

Craniosynostosis is the premature fusion of all or part of the sutures, or joints, that connect the bony plates of a newborn skull. This condition usually requires surgery before further treatment.

Plagiocephaly sketch

Early Detection & Prevention

An early sign of plagiocephaly is when creases form on one side of the neck from your baby’s head being cocked to one side. Over time these creases can turn red.

One of the best ways to look for asymmetry is to look at your baby’s head from above (the bird’s eye view) while his or her hair is wet.​

Tummy Time
Babies tend to spend more time with their heads flat against firm surfaces thanks to our busy lifestyles, the Back to Sleep program and car carrier seats. That’s why tummy time is more important than ever.

Tummy time includes any activity where your baby’s head is not flat against a surface. It encourages head and neck control and relieves pressure. Learn more about fun ways to use tummy time to interact and bond with your child in this brochure from Children's Healthcare of Atlanta.


Re​positioning is a focused effort to change the placement of your child’s head to reduce the risk of flat spots. An example is laying your baby’s head on the left side at bedtime tonight and on the right side tomorrow.

Understanding the Degree of Asymmetry

Children's Healthcare of Atlanta (CHOA) developed a plagiocephaly severity scale to categorize the varying degree of cranial asymmetries and guide clinicians in making an appropriate treatment recommendation. The CHOA scale is accepted nationwide by clinicians and insurance companies as the standard of care. Hanger Clinic used the CHOA scale as a source when developing our treatment guidelines.

Download the CHOA Scale (PDF)

Learn more about cranial asymmetry (PDF)

Cranial Asymmetry 101