240 Richmond Street, London, Ontario | Phone: 519-850-4721 | Fax: (519) 850-1816


Cranial asymmetry (CA) is a very common craniofacial condition characterized by a flat spot on the back or side of an infant’s head. 

Don’t worry, it is no one’s fault and can be easily and quickly treated!

The bones of an infants head are not fused together at birth, allowing for rapid growth during the first year of life. When external forces limit expansion in a particular area, growth will persist in the area of least resistance. Typically, there is an area of excessive flattening on one or more sides of the skull, and increased prominence in other areas of the skull.



Cranial asymmetry may present as plagiocephaly, brachycephaly, asymmetrical brachycephaly or scaphocephaly. 

  • Plagiocephaly is characterized by flattening on one side of the skull with a potential ear shift on the side of the posterior flattening. As the severity increases clinical features include posterior flattening, anterior bossing, increased diagonal cranial asymmetry, increased cranial vault, facial asymmetry, anterior ear and eye shift.  
  • Brachycephaly is characterized by flattening across the back of the skull with the cranial ratio wider than the anterior posterior length.  In these infants, there is usually posterior towering or sloping of the skull.
  • Asymmetrical brachycephaly is a combination of plagiocephaly and brachycephaly.  
  • Scaphocephaly occurs when the child has a narrow, elongated head shape.  This can be commonly mistaken for sagittal synostosis. This head shape is common with premature infants who have lengthy stays in the NICU.

CA does not affect brain development, but if left untreated it may change their physical appearance and cause other issues with facial asymmetry, difficulty fitting helmets and eyeglasses and jaw malalignment.



Risk Factor:
Most Common: Repetitive supine positioning; sleeping, in a car seat, strollers, swings etc.
Additional risk factors include: Premature birth, extended time in the NICU, Multiple births, assisted delivery, Congenital Muscular Torticollis

Conservative Management:
If asymmetry is caught early, parents are advised to practice the following conservative management tips to slow the progression of asymmetry: 

  • Increase Tummy Time
  • Repositioning & alternating sleeping direction in the crib to encourage active head turning
  • Hold your baby more

Optimal Treatment Time:
0-4 Months: Conservative Management 
4-6 Months: Optimal age to start helmet therapy
5-9 Months: Period of most cranial growth and therefore optimal correction period.

Orthotic treatment focuses on redirecting cranial growth towards normal symmetry. This is accomplished with total contact over prominent areas & allowing room for growth in areas of flattening. Throughout the infant’s development, we are guiding the direction of growth through progressive adjustments to encourage cranial symmetry.  The duration of treatment ranges as it is dependent on the child’s age of initiation of treatment, severity of asymmetry and their rate of growth. 

At Custom Orthotics of London, our specialists use the latest and greatest technologies to quantify asymmetry. We provide clinical images, 3-dimensional cranial scans, and anthropometric measurements before and after treatment to both the families and primary care physicians. 

Initial Consultation Appointment:
The initial appointment will consist of a thorough patient evaluation & parental education on cranial asymmetry. Our specialists will take clinical photographs, discuss treatment protocol and financial responsibilities. 

Initial consultations are complimentary! We want to catch the asymmetry as early as possible, so if you suspect asymmetry, call & book an appointment as soon as possible!

Casting Appointment:
If you decide to proceed with helmet therapy, our specialists will take a 3-dimensional head scan and cranial measurements. The orthotist will then take a plaster impression of the child’s head to get an exact model of the head.

Fabrication Steps:
This is not an appointment, rather it is the time that our in house fabrication team with create your child’s custom cranial remodelling helmet from the plaster impression the specialist created.

Fitting Appointment:
This appointment will occur within 2 weeks from the casting appointment. The specialist with adjust the fit of the orthosis to fit the infant’s head. The family will be educated on the wear and care schedule, complete their financial responsibilities and take the orthosis home! 

Initial Follow Up:
The first follow up appointment will occur within 7-10 days from delivery. Additional follow ups visits will occur at 2-3 weeks intervals. Depending on the infant’s head shape and response to treatment, follow up times may vary. At each follow up appointment, the specialist will assess the fit of the orthosis, monitor the head shape changes and make adjustments to direct more growth. 


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