Referral for Plagiocephaly

Primary Referral Pathway

Infants with deformational plagiocephaly, suspected craniosynostosis, or any skull shape abnormality requiring specialist evaluation should be referred to a pediatric plastic surgeon, as recommended by the American Academy of Pediatrics 1, 2, 3
The American Academy of Pediatrics guidelines explicitly state that infants with congenital malformations of the skull, including deformational plagiocephaly or craniosynostosis, should be referred to a pediatric plastic surgeon 1, 2, 3

Other acceptable specialists for referral include pediatric neurosurgeon, particularly if craniosynostosis is strongly suspected 4, pediatric otolaryngologist with craniofacial training 3, and general plastic surgeon with pediatric craniofacial experience 1, 2

Clinical examination alone is sufficient for initial specialist evaluation, and imaging is rarely necessary, as emphasized by the Congress of Neurological Surgeons guidelines 5, 6, 7
Most infants with plagiocephaly can be adequately diagnosed through detailed clinical examination by the specialist, and imaging should be reserved for equivocal clinical examinations 5, 6, 7

Do not order CT scans before referral, as this exposes infants to unnecessary radiation when clinical examination by a specialist is sufficient 5, 6, 7
Do not assume all plagiocephaly is positional, as craniosynostosis requires surgical correction and must be distinguished from benign positional plagiocephaly 5, 6, 7

The pediatric plastic surgeon will definitively distinguish positional plagiocephaly from craniosynostosis through clinical examination 5, 6, 7
The pediatric plastic surgeon will order imaging only if clinical examination is equivocal, with skull x-rays or ultrasound preferred over CT 5, 6, 7
The pediatric plastic surgeon will recommend treatment, including repositioning, physiotherapy, helmet therapy, or surgery, depending on the diagnosis 6