Referral guideline – Plagiocephaly

Introduction

Plagiocephaly is a term which means flattening of an infant’s head shape. The vast majority of these are a result of positional moulding, known as ‘deformational plagiocephaly’. Since recommendations were made to sleep infants on their backs to reduce the incidence of SIDS, there has been a dramatic increase in the incidence of deformational plagiocephaly.

There is no evidence to support the use of helmets in the majority of cases.

Plagiocephaly needs to be distinguished from the rare condition, craniosynostosis, which is premature fusion of one or more cranial sutures. Craniosynostosis can occur alone or as part of a syndrome, and is treated surgically.

GP management

  • Inspection and palpation of the infant’s skull from all angles looking for the following red flags for craniosynostosis:
    • a bony ridge along a suture line
    • a closed or triangular shaped anterior fontanelle (rather than an open, diamond shaped fontanelle)
    • unusual head appearance.
  • General examination for signs of possible genetic syndrome.
  • Check for torticollis – test passive and active neck range of motion and look for persistent head tilt to one side.
  • Review centile charts, in particular head growth.
  • Plain skull XR if craniosynostosis is considered.
  • If no red flags for craniosynostosis, normal developmental progress and normal head growth, manage conservatively and review:
    • alternate sleep position on the right and left occiput
    • have a certain amount of prone “tummy time” while awake
    • vary the position for holding and carrying the infant.

When to refer

  • If no red flags for craniosynostosis, normal developmental progress and normal head growth – manage conservatively as above and review.
  • If there is torticollis, persistent head tilt or tight neck muscles – consider paediatric physiotherapy referral (private or Child Development Program).
  • If abnormal head shape is associated with developmental concerns, or deformation is severe, refer to a paediatrician or Child Development Program.
  • If skull XR is abnormal, refer to paediatrician or plastic reconstructive surgeon.

Essential referral info

  • History of presenting complaint and evolution of skull shape
  • Examination findings including head circumference
  • Skull XR (if referring to general pediatrics or plastic and reconstructive surgery)
  • Patient details
  • Medicare number
  • Parent/carer name and contact details
  • Referring clinician details (name, contact details, provider number, date and length of referral)

From 1 May 2019 referral criteria will apply at CHQ. This condition has minimum demographic and essential clinical referral information that is required to be included prior to submission of the referral. Visit the CPC website for the required condition. If you are unable to provide the required “essential information” please state the reason when you submit the referral.

Helpful referral info

  • Birth and antenatal history including whether breech presentation or multiple pregnancy, other complications of pregnancy, duration of gestation and birth weight
  • History of sleeping position
  • Family history of abnormal head shape
  • Height and weight
  • Other medical history