Alternative Treatment for Infant Brachycephaly and Plagiocephaly Without a Cranial Band

A flat spot on a baby’s head can feel urgent, especially when it appears alongside a head tilt, tight neck motion, or visible facial asymmetry. Cranial remodeling helmets and bands are often discussed in these cases, but they are not the only approach explored in clinical writing.

A case report by Keila Nichols, DC, describes the resolution of infantile brachycephaly, plagiocephaly, and torticollis without the use of a cranial remodeling orthosis. The report focuses on a 3-month-old infant with nonsynostotic cranial deformation, meaning the skull shape changes were not caused by premature fusion of skull sutures.

This post summarizes the case, explains why assessment matters, and places the findings in a practical, cautious context. It is for informational purposes only and should not replace care from a pediatrician or qualified pediatric specialist.

Early positioning and movement matter in infant head shape care.

What brachycephaly and plagiocephaly mean

Brachycephaly and plagiocephaly are common terms used to describe infant head shape differences.

Brachycephaly usually refers to a head shape that is wider and shorter from front to back. Parents may notice broad flattening across the back of the head.

Plagiocephaly describes asymmetry. One side of the back of the head may look flatter than the other, and the forehead, cheek, or ear position may appear uneven.

In this case report, the infant had both. The exam described general flattening of the occiput, which is the back portion of the skull, plus more specific flattening on the right side near the lambdoidal suture. The posterior parietal bones were also described as positioned upward, giving the back of the skull a taller appearance.

The infant also had right lateral flexion torticollis, a pattern where the neck favors bending to one side. This matters because limited neck motion can reinforce uneven pressure on the skull. If a baby repeatedly rests on one area, shape changes can become more noticeable over time.

Why nonsynostotic cranial deformation is different

The case involved nonsynostotic cranial deformation. That distinction is central.

In nonsynostotic cases, the skull sutures are not prematurely fused. The skull remains capable of growth and change. By contrast, craniosynostosis involves early fusion of one or more sutures and requires medical evaluation, often by specialists.

That is why assessment comes first. A flat spot should not be treated as one simple problem with one simple answer. A clinician needs to consider:

• Whether sutures are open or fused

• How the infant moves the neck

• Whether there is a persistent head tilt

• How the face, forehead, and ears align

• Whether feeding, sleep position, or preferred turning patterns play a role

• Whether referral for imaging or specialist evaluation is needed

  
  

The case report’s main message is not that every infant can avoid a helmet. A better reading is this: the cause of the shape change should guide the care plan.

What the case report found during assessment

Nichols described several cranial and neck findings that were used to guide care. These included restriction near the lambdoidal suture, especially on the right side, and an occipital flexion pattern associated in the report with shortened front-to-back head distance, cranial membrane tension, a high palate, and posterior skull flattening.

The report also described a clockwise lateral strain at the sphenobasilar junction, an area where the sphenoid and occipital bones meet at the base of the skull. In the author’s clinical interpretation, this pattern contributed to both plagiocephaly and torticollis.

These terms come from cranial technique frameworks used by some chiropractic and manual therapy clinicians. They are not the same as a standard helmet fitting assessment, and the case report itself calls for better measurement, photography, and training to support future research.

That caution is important. A single case report can show what happened in one infant under one provider’s care. It cannot prove that the same outcome will happen for all babies with similar head shape findings.

Manual approaches are based on careful assessment and gentle handling.

How care was approached without a cranial band

The report describes an alternative treatment for infant brachycephaly and plagiocephaly without a cranial band that focused on restoring motion and reducing strain patterns rather than using an external remodeling orthosis.

The care goals included:

• Releasing restriction around the lambdoidal region

• Reducing sphenobasilar torsion

• Restoring motion of the occiput

• Redirecting cranial malposition patterns

• Addressing the torticollis linked with the cranial asymmetry

  
  

The report does not present the care as a simple at-home fix. It describes clinician-directed cranial technique. For families reading about this topic, that matters. Gentle positioning, tummy time, and neck mobility strategies may support many infants, but persistent asymmetry or torticollis should be evaluated.

A pediatrician, pediatric physical therapist, pediatric chiropractor with infant training, craniofacial specialist, or other qualified provider may be involved depending on the findings and local standards of care.

The reported outcome at 9 months

At 9 months of age, the case report describes full resolution of the infant’s brachycephalic and plagiocephalic asymmetries, the superior parietal positioning, and the torticollis.

That is the striking part of the article. The infant’s head shape and neck pattern reportedly improved without a DOC Band, STARband, or similar cranial remodeling orthosis.

Still, the result should be read with balance. The report is valuable because it documents a clinical pathway and outcome. It also highlights gaps that need better study. The author specifically calls for improved research using precise measuring devices, higher-quality photography, and more accessible training in infant cranial technique.

Those are reasonable next steps. Better documentation would help families and clinicians compare approaches more clearly, including repositioning, physical therapy, manual therapy, helmet therapy, or combined care.

What families can take from this case

This case report supports a thoughtful idea: infant head shape care should begin with a careful assessment, not an automatic assumption.

For some infants, a cranial band may still be appropriate. For others, especially when torticollis, motion restriction, or positional habits are major factors, conservative care may play an important role. The key is to identify what is driving the asymmetry and to monitor progress with objective measures when possible.

The most useful takeaway is simple. If a baby has a flat spot, facial asymmetry, or a persistent head tilt, seek an early evaluation. Early care gives clinicians more time to guide growth, improve motion, and decide whether a helmet, manual care, physical therapy, or another approach fits the child’s needs.

Citation

Nichols, K., DC. Resolution of infantile brachycephaly, plagiocephaly, and torticollis without the use of a cranial remodeling orthosis: A case report.