Positional Plagiocephaly: Definition, Diagnosis and Treatment

has risen in prevalence in the supine-sleep era. This review synthesizes current evidence on definition, differential diagnosis, assessment, and treatment, emphasizing practical steps for frontline clinicians. PP should be differentiated from craniosynostosis by careful history, examination of sutures and ridging, ear position, and the pattern of frontal/parietal bossing; targeted imaging is reserved for equivocal cases. Major risk factors include limited supervised prone time, preferential head positioning, congenital muscular torticollis, prematurity, multiple gestation, and prolonged device use. Severity should be documented with standardized grading (e.g., Argenta) and quantitative indices such as the cranial vault asymmetry index. First-line management is conservative—parental education on repositioning, generous daily “tummy time,” and prompt physiotherapy when torticollis is present. For moderate–severe or persistent asymmetry despite these measures, cranial orthosis is most effective when initiated between 4 and 6 months and seldom indicated beyond 12 months. Prognosis is generally excellent, with earlier intervention yielding faster and greater correction. Clinically, PP is best addressed proactively in primary care through routine head-shape and neck range-of-motion screening at all well-baby visits in the first year, early identification of torticollis, structured counseling that preserves supine sleep for SIDS prevention while increasing daytime prone positioning, and timely reassessment within 4–6 weeks. Multidisciplinary pathways linking pediatricians, physiotherapists, orthotists, and craniofacial teams by 4–6 months for non-responders optimize outcomes and minimize overtreatment.