Positional Plagiocephaly- a common uneven head shape in babies

Positional plagiocephaly is a medical term to describe an uneven head shape with a flat spot on one side of the occiput (back of the head) due to positional issues. Sometimes, there may be changes involved other parts of the head such as forehead, eyes, nose, cheeks or ears. Positional plagiocephaly is usually developed over time. Nearly 1 in 3 young babies have a noticeable plagiocephaly between the age of 2 to 3 months. Dr Amy’s research is studying different factors that contribute to the development of positional plagiocephaly. By understanding the risk factors, we can target on implementing prevention strategies that can help babies to develop a symmetrical head shape. These strategies are also helpful when the baby already has positional plagiocephaly.

3 Questions to ask:

  1. Does my baby prefer to turn their head to one side more than 3/4 of the time?
  2. Does my baby spend more than 15 hours per day on their back?
  3. Does my baby sleep more than 5 hours on their back in one sleep?

If you have 2 yes from the 3 questions, please check your baby’s head shape.

How to check whether my baby has plagiocephaly?

By looking

Usually we look at babies from the front. A flat spot on the occiput is much easier to see when you look from the top of the head (bird’s eye view). In some babies, you may see a bulging part at the other side of the occiput.

By measuring

Dr Amy has developed a method to measure plagiocephaly. It is simple and accurate. If you are unsure whether your baby has a flat spot, book an appointment to see Dr Amy to have it checked out. Dr Amy will also provide helpful strategies to prevent your baby from developing plagiocephaly or advice on the management if the plagiocephaly is significant.

What to do if my baby has plagiocephaly?

Talk to your doctor in the first place to rule out whether the cause of the flat spot is not from early closure of cranial sutures (craniosynostosis). The cranial suture is the gap between 2 skull bones which should be opened for a length of time to allow brain growth. If there is early closure, this will affect the head shape and brain growth.

Implement strategies that you may already learn to avoid too much pressure on the flat spot. Some strategies may work, some others may not. If you are in doubt, book an appointment to see Dr Amy. She has seen hundreds of babies with plagiocephaly. Her research studies provide contemporary and important information in this area. Dr Amy is striving to help you and your baby.

What to do if my baby does not have a flat spot?

With the 2 yes in the above 3 questions, your baby may be at risk of developing a positional plagiocephaly.

Implement strategies that you may already learn to avoid too much pressure on the occiput. Some strategies may work, some others may not. If you are in doubt, book an appointment to see Dr Amy. She has seen hundreds of babies with plagiocephaly. Her research studies provide contemporary and important information in this area. Dr Amy is striving to help you and your baby.

[Part 5] Early Intervention

In early stage of life, brain is most flexible or “plastic” to adapt a wide range of environments and interactions, but as the maturing brain becomes more specialized to assume more complex functions, it is less capable of reorganizing and adapting to new or unexpected challenges.

Therefore, promote healthy brain development by influence a baby’s developing brain is easier and more effective than to rewire parts of its circuitry in the adult years.

We have to maximise positive stress and minimise toxic stress

There are various ways to promote brain and child development, physical activity is one of the ways.

Physical activities are important for all ages, including babies and older people.
Physical activity is a simple, yet important, method of ensuring better cognitive development in a child at an early age.

It helps improve memory, learning ability, and also reduces the risk of late-life cognitive impairment and dementia (Chaddock et al., 2010).

Exercise also helps improve circulation of blood and oxygen to the brain. This ensures improved nerve functioning that enhances your child’s overall physical, cognitive and psychological health.

A 2008 study published in Educational Psychology Review reports that systematic exercise programs may actually enhance the development of specific types of mental processing known to be important for meeting challenges encountered both in academics and throughout life (Tomporowski, Davis, Miller & Naglieri, 2008).

Another study published in 2010 in Brain Research found that children who are physically fit have a bigger hippocampus and perform better on a memory test than their less-fit peers (Chaddock et al., 2010).



Chaddock, L., Erickson, K. I., Prakash, R. S., Kim, J. S., Voss, M. W., VanPatter, M., … Kramer, A. F. (2010). A neuroimaging investigation of the association between aerobic fitness, hippocampal volume, and memory performance in preadolescent children. Brain Research, 1358, 172–183. http://doi.org/10.1016/j.brainres.2010.08.049

Tomporowski, P. D., Davis, C. L., Miller, P. H., & Naglieri, J. A. (2008). Exercise and Children’s Intelligence, Cognition, and Academic Achievement. Educational Psychology Review, 20(2), 111–131. http://doi.org/10.1007/s10648-007-9057-0

[Part 4] Experience and Brain Development

Is nurturing affect brain and child development?

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The brain is developed over time, from the bottom up. The basic structure of the brain is built through a continuous process that begins before birth and persists into adulthood.This development of the brain is influenced by many factors, including a child’s relationships, experiences and environment.

Source: Berk & Roberts, 2009, p.28

There are some changes in the early childhood brain:

  • Increase rate of myelination
  • Synaptic pruning
  • Increase in mass of brain
  • Increase in circumference of the skull

Brain lobes and development:

  • Occipital—visual cortex develops early (e.g. face recognition)
  • Temporal—language learning; continues to develop across early childhood
  • Parietal—movement, orientation, recognition, perception of stimuli (eye-hand coordination)
  • Frontal—reasoning, planning, parts of speech, movement, emotions, and problem-solving (develops into young adulthood). Hippocampus—memories; immaturity related to infantile amnesia
Brain Hierarchy
Brain Hierarchy (Source: Integrated Learning Strategies Learning Corner)

Positive experiences

In a positive environment (interaction between children and adults), for example, young children naturally reach out for interaction through babbling, facial expressions, gestures, and adults respond with the same kind of vocalizing and gesturing back at them, the brain’s neural connections and pathways have a better chance of becoming wired together.

The brain is a highly interrelated organ, and its multiple functions operate in a richly coordinated fashion.

Brain development is “activity-dependent”. Every experience stimulates some neural circuits and leaves others alone. Repeated use of neural circuits will be strengthened, those that are not used are chopped off resulting in “pruning”.

The emotional and physical health, social skills, and cognitive-linguistic capacities that emerge in the early years are all important pre-requisites for success in school and later in the workplace and community.

Negative experiences

Negative experiences cause “toxic stress” and body release a toxic hormone called “cortisol” which damages brain structure, and can lead to life-long problems in learning, behaviour, physical and mental health; while positive experiences lead the body releases those happy hormones include endorphin, dopamine and serotonin.

Source: University of Rochester

Negative experiences include the following types:

    • Physical Abuse:
      • Striking a child causing some level of physical harm
      • Can be unintentional arising from punishment that escalated
      • Can be intentional
    • Neglect:
      • Failure to provide for basic needs (social, emotional, educational, physical)
      • Includes abandonment, leaving the child alone and unsupervised
    • Psychological:
      • Degrading
      • Threatening
      • Isolating

Outcomes of Negative experiences

Physical Changes:

  • Lowered reactivity to stressors (non-reactive salivary cortisol)
  • Hippocampus may be smaller

Psychological Impacts:

  • Move from trust to mistrust (ala Erikson)
  • Use of violence to deal with conflict
  • Lack of sympathetic response to others’ distress
  • Little evidence that an abused kids grow up to be abusive parents
  • Lower achievement in academics than abused children
  • Poor social development with withdrawal
  • Poor emotional control

In summary, while positive stress (moderate, short-lived physiological responses to uncomfortable experiences) is an important and necessary aspect of healthy development, toxic stress is the strong, unrelieved activation of the body’s stress management system and may cause changes of brain architecture.

Source: Center on the Developing Child – Harvard University



Berk, L. & Roberts, W. (2009). Child development (3rd Canadian ed.). Toronto, ON: Pearson Allyn and Bacon.

[Part 3] Brain development

90% of a child’s brain development happens before AGE 5

Newborn Brain Development
(about 0 month to 2 years old)

At birth, approximately 100 billion neurons present in baby’s brain.

The newborns explore their senses and the world, but they are lack of skills and have little control over their limbs. They rely upon basic reflexes such as sucking and grasping.

As different regions of the brain develop, these reflexes are rapidly replaced by more complex neural pathways to accommodate different abilities. Strong sensations and physical stimuli are critical for synaptic growth in the cerebellum, a region that regulates coordination and muscle control (Angier, 1992).

Brain lobes development affects motor development and locomotor skills that

  • Walking becomes smoother
  • Stair climbing—both feet brought to the same step before moving upward or downward
  • Eye-hand and eye-foot coordination improves
  • Running and jumping become easier
  • Balance improves
  • Based on maturation, experience, and encouragement

(Study Resource, n.d.)

The main driving force for babies is exploring the world. Getting them to do so is fundamental to their development. In addition, other building blocks are healthy foods, plenty of water, and physical activities.

Toddler Brain Development
(about 2 to 5 years old)

By age 2, the brain is 80% of adult size and the number of synapses reaches adult levels.

By age 3, a child’s brain has about 1,000 trillion synapses or about twice the number of an adult’s brain and is two and a half times more active (Shore, 1997).

Fine and gross motor skills develops independently, but both require the formation of synapses and mylenation (a neuronal coating that isolates the loss of electrical signals). The neural circuits that connect the motor cortex and muscle are intensified by repetitive motor activities.

Children need to use their arms and legs including walking, running, jumping and playing, if who are suppressed to explore the world, they may cause a lot of trouble.

At this time, the brain begins to decelerate and reduce nervous connections through a process called “pruning” like trimming off excessive tree branches, so that brain circuits become more efficient.

Source: Center on the Developing Child – Harvard University.

Brain lobes development also affects fine motor skills:

  • Require greater care and control
  • Begin stacking blocks, molding clay, scribbling, etc
  • More accurately perform tasks such as writing with an adult-like grip, cutting with blunt scissors, opening screw-top containers (cause for caution) etc.
Brain Architecture

Many of the habits and characteristics of a person have already been developed. If the child’s motor neurons do not trained the specific athletic skills as early as possible, then the child may not perform outstandingly in this skill. The lifelong desire and specific way to learn, read and explore the world have been developed.

The importance of motor skills

Young Child Brain Development
(about 4 to 7 years old)

Synaptic density remains tremendous saturated during the first decade of life, followed by a decrease in density.

Children’s brain development has slowed, but still more than adults nearly 10 times. They are still able to learn, but now they are able to read and acquire new information by themselves.

Brain Development of Children
from 7 to adolescent

95% of brain growth is reached by the time a child reaches the age of 9.

As children grow, the brains of adolescents develop more slowly. Different stages of brain development begin with more years and are more regarded as hormonal changes than actual changes in the brain.



Angier, N. (1992). The purpose of playful frolics: Training for adulthood. The New York Times, Oct. 20, B5-B6.

Shore, R. (1997). Rethinking the brain: new insights into early development. New York: Families and Work Institute.

Study Resource. (n.d.). Physical development in early childhood. Retrieved on December 20, 2017 from http://studyres.com/doc/8291904/physical-development-in-early-childhood

[Part 2] Brain structure and development

Nerve-Neuron and Synapse

The function of the brain depends on activities of neurons (brain cells) and synapses (connections) that receive and send electrochemical signals (messages).

How neuron works
Cells interactions

Each neuron has an axon (trunk) which sends messages to the small structures – dendrites (fingers) of another neuron. When the axon connects with the dendrite of another neuron, a synapse (connection) is formed, where is like a station of interchange messages.

[Part 1] The relationship between brain development and early childhood

Is early brain development affect child development?

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The science of early brain development can provide vital information to early childhood investment. These basic concepts have been established by neuroscience and behavioral researchers for decades that help to explain why children’s development, especially from birth to five years, is the foundation of a wealthy and sustainable society.

Genes and environment interact throughout brain development that genes determine neurons, connections among major brain regions, while environment and experience refine the connections, enhancing some connections while eliminating others.

The Basic Science of Pediatrics

Early brain development affects childhood development in different important areas including physical, emotional and behavioral:

  • Motor skills
  • Cognition
  • Self-control or self-regulation
  • Language or communication
  • Learning
  • Social-Emotional function

It seems the impact is wide-ranged and comprehensive.

If you would like to know how the impact occurs, you should first understand the brain structure and development.