Plagiocephaly Treatment 101

Cranial remolding orthoses (CROs), also commonly referred to as bands or helmets, are FDA class II medical devices that are proven to effectively treat irregular head shape conditions. Your baby’s natural growth does all of the work, while the cranial band simply provides a symmetrical space into which your child’s head will grow, gently shaping the skull over time.

Clinical Evidence

There are many studies documenting the effectiveness of CRO treatments. To learn more about plagiocephaly treatment, we recommend this two-part article on “Evidence-Based Care of the Child with Deformational Plagiocephaly:”

Part I: Assessment and Diagnosis

Wendy S. Looman, PhD, RN, CNP, and Amanda B. Kack Flannery, MS, RN, CNP, 2011. Evidence-Based Care of the Child With Deformational Plagiocephaly, 1: Assessment & Diagnosis. Journal of Pediatric Health Care. Volume 26 Number 4 (2011). View full text.

Design: A systematic review of literature published between 2000 and 2011 on Deformational Plagiocephaly.

Abstract: Non-synostotic deformational plagiocephaly (DP) is head asymmetry that results from external forces that mold the skull in the first year of life. This common condition affects as many as one in five infants in the first two months of life. Primary care providers are most likely to encounter DP when infants present for well-child care, and for this reason it is important that providers be competent in assessing, diagnosing, and participating in the prevention and management of DP. Part I of this series provides a brief background of DP and associated problems with torticollis and infant development, and we present strategies for visual and anthropometric assessment of the infant with suspected DP. We also provide tools for differentiating DP from craniosynostosis and for classifying the type and severity of DP.


  • DP is a common condition, particularly in cultures where infants sleep in the supine position (on their backs). This sleeping position is associated with a significant reduction in the risk of sudden infant death syndrome (SIDS), but it also may be associated with molding of the infant’s head, especially before the infant develops motor skills.
  • Research suggests that cumulative exposure to the supine position is a primary factor in the development of DP. Torticollis, variable tone, and developmental delay may be present in children with DP, and the assessment of the infant should include particular attention to development and tone.
  • DP generally becomes more severe in the first weeks of an infant’s life, because the infant has little active positioning of the head; then the head shape begins to improve with progression of normal development. The peak prevalence of DP is 4 months of age.
  • Since the American Academy of Pediatrics’ Back to Sleep campaign began in 1992, the incidence of DP referrals increased 600%.
  • Emerging evidence suggests that infants with DP are less active, have variable tone and are delayed in some areas of development compared with their age-matched peers.
  • Infants’ heads grow rapidly in their first 6 months. Head circumference increases by about 2 cm per month in the first 3 months, 1 cm per month between 4 and 6 months and 0.5 cm per month after 6 months. Early prevention and management of this condition are important.

Part II: Management

Amanda B. Kack Flannery, MS, RN, CNP,Wendy S. Looman, PhD, RN, CNP, & Kristin Kemper, MS, RN, CNP. Evidence-Based Care of the Child With Deformational Plagiocephaly, 2: Management. Journal of Pediatric Health Care. Volume 26 Number 5 (2011). View full text.

Design: A systematic review and grading of literature on management of Deformational Plagiocephaly (DP) from 2000 and 2011 based on level of evidence and quality.

Abstract: Part II in this two-part series presents a synthesis of the evidence related to management of deformational plagiocephaly and an evidence-based clinical decision tool for multidisciplinary management of DP. The evidence suggests that although many cases of DP will improve over time, conservative management strategies such as repositioning, physical therapy, and cranial molding devices can safely and effectively minimize the degree of skull asymmetry when implemented in the first year of life. Outcomes are best when the timing of diagnosis and severity of asymmetry guide decision making related to interventions and referrals for DP. Prevention and management of early signs of DP are best achieved in a primary care setting, with multidisciplinary management based on the needs of the child and the goals of the family.


  • Management of deformational plagiocephaly depends on the age of the infant and the degree of head asymmetry and should be evidence-based and family-centered.
  • The consistency and quality of evidence related to conservative management of DP is improving over time with the addition of randomized controlled trials and more rigorously designed studies.
  • This evidence indicates that DP is primarily a cosmetic concern in terms of long-term outcomes, but conservative management strategies can minimize the degree of asymmetry if they are implemented early.
  • Early and continued assessment of infant development is essential.
  • For parents who wish to pursue cranial molding therapy, there is no evidence of harm from this intervention, and the likelihood of success is high if treatment begins by six months of age.
  • Conservative management strategies can minimize the degree of asymmetry if they are implemented early.
  • The cost of treatment can be high and may not be covered by insurance.

Cranial Scanning

A three-dimensional scan can help diagnose the degree of asymmetry in your child’s head and is also used to design and build the cranial band to fit your baby perfectly. Scanning is quick, easy, safe, radiation-free and painless. It creates a detailed model of the contours of your baby’s head without using plaster casts. Scanning your baby before, during and at the end of treatment enables you to see your child’s treatment progress.

Baseline Scans

You and your pediatrician may just keep an eye on your baby’s head shape as it develops through your child’s first few months. A baseline scan is a great way to get accurate measurements that can be repeated later to determine if the situation is improving or worsening. Hanger Clinic offers complimentary evaluation scans.

Find a Hanger Clinic location in your area to schedule a free evaluation.

Plagiocephaly Treatment