What is the recommended treatment for a 2-month-old infant with plagiocephaly?

Management of Plagiocephaly in a 2-Month-Old Infant

For a 2-month-old infant with plagiocephaly, supervised tummy time while awake is the primary recommended treatment, along with varying head position during sleep and minimizing time in positioning devices. 1

Assessment and Diagnosis

• Evaluate for associated torticollis (neck muscle tightness)
• Rule out craniosynostosis (premature fusion of skull sutures) which would require surgical intervention
• Assess developmental milestones to ensure normal progression

First-Line Treatment Approach

1. Daily supervised tummy time:

   • Begin with short periods (3-5 minutes) several times daily 1
   • Gradually increase duration as tolerated
   • The American Academy of Pediatrics recommends supervised, awake tummy time as a B-level recommendation to facilitate development and minimize positional plagiocephaly 2

2. Repositioning strategies:

   • Alternate head position during sleep while maintaining supine (back) sleeping position 1
   • Change crib orientation periodically to encourage infant to look in different directions
   • Hold infant in upright position when awake
   • Alternate sides when feeding

3. Limit time in positioning devices:

   • Minimize time in car seats, swings, and bouncy seats to necessary use only 1
   • Avoid prolonged time in any single position

Important Safety Considerations

• Continue placing infant on back to sleep to reduce SIDS risk (A-level recommendation) 2
• Never compromise safe sleep practices while addressing plagiocephaly
• Ensure tummy time is always supervised and only when infant is awake

Monitoring and Follow-up

• Expect gradual improvement over weeks to months
• Reassess in 4-6 weeks to monitor progress 1
• If no improvement after 2-3 months of repositioning therapy, consider referral to specialist

Second-Line Interventions (if needed later)

• Physical therapy may be indicated if plagiocephaly is associated with torticollis 1, 3
• For moderate to severe cases that don't improve with repositioning by 4-6 months of age, helmet therapy may be considered 4

Parental Education

• Early parent guidance effectively reduces the prevalence and severity of plagiocephaly 5
• Educate parents about creating a nonrestrictive environment that promotes spontaneous physical movement and symmetrical motor development

Prognosis

• Mild plagiocephaly typically improves with conservative management
• Early intervention is essential for optimal outcomes 3
• In healthy children, incidence decreases spontaneously from 20% at 8 months to 3% at 24 months 1

Starting treatment at 2 months of age provides an excellent opportunity for successful conservative management, as the skull remains highly malleable at this stage and early intervention has been shown to be most effective.