Positional plagiocephaly is a cranial vault deformation in the presence of open cranial vault sutures with no negative neurologic consequences. A distinct morphologic pattern and patent cranial sutures noted on confirmatory radiographic studies distinguish positional plagiocephaly from abnormal head shapes secondary to craniosynostosis. Management consists of conservative (nonsurgical) means, depending on the extent of the cranial asymmetry and any contributing etiologic factors. Clinicians must be well versed in the differential diagnosis of plagiocephaly to determine if treatment should be surgical or nonsurgical. Positional plagiocephaly is a nonsynostotic condition in which there is a deformation of the cranial vault in the presence of otherwise open, normally functioning sutures. The reported incidence of positional plagiocephaly has increased with the implementation of "Back to Sleep" guidelines for the prevention of sudden infant death syndrome. Pediatricians also have maintained an increased awareness of the importance of early referral for evaluation of abnormal head shape during infancy.