Babies are cute. They have little toes, and button noses, and hopefully, tiny round heads. Unfortunately, 1 in 10 infants may have positional plagiocephaly, a deformation of an infant's head (one-sided flatness). It is caused by continuous pressure on one part of a baby's skull. The condition isn't just a cosmetic issue -- it can become a hardship for children who have to take invasive measures to have it corrected.

With the newer sleep practices being employed as a result of SIDS prevention, physicians are seeing an increase in this deformation. Plagiocephaly can be prevented by employing the TOTS system:

Tummy time

Opposite side of the crib

Turn your baby's head

Switch Arms

In addition, the development of the Symmetry Sleep System (which we review tomorrow) has been shown to be effective in preventing Plagiocephaly and is compatible with the SIDS prevention guidelines.

Recently we had the pleasure of talking to Dr. Plagio, a.k.a Ricardo Guillermo Hahn, a professor and past chair of the Department of Family Medicine at the University of Southern California, School of Medicine. He gave us more information on this condition, the potential problems it may cause, and how we can prevent it.

Q: Do we know how many babies are diagnosed with Plagiocephaly? If so, can we assume that there are a larger number of infants that have it but are not diagnosed?

A: Unfortunately, this condition is often treated very dismissively by the medical community. Many physicians tell their patients not to worry and that the flattening will go away. In most cases, the condition will correct itself and other times it leads to plagiocephaly. Therefore, it is difficult to estimate the sum of infants diagnosed with plagiocephaly because no one is really keeping track of the amount of diagnosed cases.

In my experience, and from our test study (which included a sample size of about 500 infants), I would estimate the amount at about 1 in 6 to 1 in 10.


Q: I had not heard of this condition prior to my introduction to your website. What is being done to bring this type of education to the hospitals and birth centers in the U.S. to help let new mothers know about plagiocephaly and the TOTS system?

A: This issue is one of awareness. It is my belief that awareness of Plagiocephaly should be brought forth in pre-natal classes and, first and foremost, by the media. We need the media to shed light on this phenomenon and to help communicate the ways to prevent Plagiocephaly to the general public. Together with Basic Comfort, we have launched a national media campaign to raise awareness about plagiocephaly, how to prevent and correct the condition before it is too late.

Q: How old is too old for an infant to start using the TOTS system or the Symmetry Sleep System?

A: It is best to start implementing repositioning techniques as soon as flattening is apparent. The Symmetry Sleep System is approved for infants up to 6 months. However, the product can be used until the plates are fully fused, which usually happens after the child is a year old. After a child reaches a year of age, and nothing has been done to correct the flattening, surgical intervention might be necessary.

Q: What should a parent do if, after bringing a concern of plagiocephaly to their doctor, it isn't taken seriously?

A: A good doctor knows that they and the parents are on the same team, with the shared goal of helping a child grow happy and healthy. If your doctor dismisses your questions or won’t take your concerns into account, it may be time to look for a new doctor. Parents can also contact us via the Dr. Plagio website, where we can put them in touch with specialists who are willing to listen and help.


We would like to thank Dr. Plagio for his time and expertise on the subject. If you have additional questions, would like to know more about plagiocephaly, or want to see how to adopt the TOTS system with your baby, visit DrPlagio.org