Obstetric/birth history — intrauterine moulding can be related to mal presentation. Children who are floppy tend to have malpresentation. Birth trauma moulding tends to resolve in first few weeks of life.

Prematurity predisposes to plagiocephaly and babies have higher risk of associated central nervous system problems such as hydrocephalus.

Developmental history.

Ask about how much time baby spends on tummy/back.

General development

Look for dysmorphism (premature synostosis of cranial suture +/- syndrome, for example, Crouzon's)

Head size; can be difficult to measure largest circumference. Record head (= brain) growth in parent held record and monitor this.

Head exam; check for fontanelle and any ridging of cranial sutures.

Look at ears. In plagiocephaly accentuated by sleeping position, the head resembles a parallelogram: the ear ipsilateral to flattening moves forward and is associated with cranial bossing on affected side. In craniostenosis; the ear is pushed back (not forward).

Eye movements: if the baby has a squint, he/she will preferentially look one way and so encourage plagiocephaly. Check for other visual problems for example, hemianopia.

Neck movements; exclude torticollis, traumatic sternomastiod tumour.

Shoulder and upper limb; examine for muscular symmetry.

Muscle tone — babies with general floppiness will tend to develop plagiocephaly/brachiocephaly as they move less, so do query underlying neurological or metabolic problem.

Hips — limited movement in one hip will encourage baby to lie one way.

If torticollis refer to physiotherapy.

Refer if abnormal findings — especially note: developmental delay; weakness or hypotonic; suspected craniostenosis (neurosurgical referral); head circumference crossing centiles; head circumference out of keeping with weight and/or height; abnormal hip position.