👶Flat Head Syndrome (Positional Plagiocephaly)
Understanding and preventing positional head flattening in infants
What Is Flat Head Syndrome?
Flat head syndrome usually happens when a baby sleeps with the head turned to the same side during first months of life. This causes a flat spot, either on one side or the back of the head.
Flat head syndrome is also called positional plagiocephaly (pu-ZI-shu-nul play-jee-oh-SEF-uh-lee).
📊Types of Positional Head Deformities
🔄Plagiocephaly
Asymmetric flattening on one side of the head, often causing the head to appear tilted or lopsided.
- • Most common type
- • One ear may appear forward
- • Forehead may bulge on opposite side
- • Often affects the back-right side
⬆️Brachycephaly
Symmetric flattening across the back of the head, making the head appear wider and shorter.
- • Back of head is flat
- • Head appears wider than normal
- • May be associated with torticollis
- • Less common than plagiocephaly
🔺Scaphocephaly
Elongated, narrow head shape, often associated with premature birth or craniosynostosis.
- • Head appears long and narrow
- • May indicate craniosynostosis
- • Requires medical evaluation
- • Less common positional cause
🔍Causes and Risk Factors
Primary Causes:
- •Prolonged time spent on back (Back to Sleep campaign)
- •Limited tummy time during awake periods
- •Preference for looking in one direction
- •Congenital muscular torticollis (tight neck muscles)
- •Multiple births (twins, triplets)
Additional Risk Factors:
- •Premature birth (softer skull bones)
- •Large birth weight or rapid growth
- •Extended time in car seats or swings
- •Sleeping in the same position consistently
- •Male babies (slightly higher risk)
🛡️Prevention Strategies
🔄Position Changes
- •Alternate head position: Gently turn baby's head to different sides during sleep
- •Change crib position: Move crib or change baby's position in the crib
- •Rotate baby's position: Alternate which end of the crib baby's head faces
- •Hold baby in different positions: Vary how you carry and hold your baby
🏃Tummy Time and Movement
- •Supervised tummy time: Start with 3-5 minutes, several times daily
- •Side-lying play: Place baby on their side for supervised play
- •Carry baby upright: Use baby carriers and slings when possible
- •Limit time in containers: Reduce time in car seats, swings, and bouncers
Signs and Detection
👀Visual Signs
- •Flat spot on one side of the head
- •Head appears tilted or lopsided
- •One ear appears more forward than the other
- •Forehead may bulge on one side
- •Hair may be thinner or missing in flat area
🔍How to Check
- •Look at baby's head from above
- •Check for symmetry from the front
- •Feel for flat areas with your hands
- •Notice if baby always looks in one direction
- •Take photos to track changes over time
🛠️Treatment Options
🏠Conservative Treatment (0-6 months)
- •Repositioning therapy: Consistent position changes and tummy time
- •Physical therapy: For associated torticollis or muscle tightness
- •Environmental changes: Modify sleep and play environments
- •Parent education: Learn proper positioning techniques
🏥Medical Treatment (6+ months)
- •Cranial orthosis (helmet therapy): Custom-fitted helmet to reshape skull
- •Band therapy: Similar to helmet but with different design
- •Surgical intervention: Rare, only for severe cases or craniosynostosis
- •Continued therapy: Physical therapy for associated conditions
Age-Specific Information
👶0-3 Months
- • Focus on prevention
- • Start tummy time early
- • Alternate head positions
- • Monitor for early signs
- • Skull is most malleable
👶3-6 Months
- • Repositioning therapy most effective
- • Physical therapy if needed
- • Continue prevention strategies
- • Monitor progress closely
- • Consider early intervention
👶6+ Months
- • Helmet therapy may be needed
- • Skull bones hardening
- • Less responsive to repositioning
- • May require medical evaluation
- • Treatment window closing
⚠️When to Seek Professional Help
Consult with your pediatrician or a specialist if:
- Flat spot is severe or getting worse despite repositioning
- Baby has difficulty turning their head in both directions
- Head shape doesn't improve by 4-6 months of age
- You notice facial asymmetry or ear misalignment
- Baby shows signs of developmental delays
- You have concerns about your baby's head shape
- Family history of craniosynostosis or other skull conditions
❓Frequently Asked Questions About Flat Head Syndrome
What causes flat head syndrome?
The most common cause of a flattened head is a baby's sleep position. Infants are on their backs for many hours every day, so the head sometimes flattens in one spot. This happens not only while they sleep, but also from being in infant car seats, carriers, strollers, swings, and bouncy seats. Flat head syndrome can even start before birth if there's pressure on the baby's skull from the mother's pelvis or a twin.
Is flat head syndrome dangerous for my baby?
Flat head syndrome doesn't affect a baby's brain growth. It's primarily a cosmetic concern. However, having a stiff neck (torticollis) can slow early development. The condition improves with time and natural growth, and most cases resolve without treatment as babies grow and begin to change position themselves during sleep.
Should I stop putting my baby to sleep on their back?
No, you should always place babies on their back to sleep to help prevent sudden infant death syndrome (SIDS), even with the possibility of flat head syndrome. Avoiding swings, car seats, bouncy chairs, and other devices is safest for sleep and also helps to make sure that babies can move their head freely.
How can I prevent flat head syndrome?
Practice tummy time, vary positions in the crib, and limit time in "containers" like car seats and swings. Provide plenty of supervised time for your baby to lie on the stomach while awake during the day. Position your baby in the crib to encourage active turning of the head to the side that's not flattened.
What is torticollis and how does it relate to flat head syndrome?
Torticollis is tight neck muscles that make it hard for babies to turn their heads. Because it's hard to turn their head, babies tend to keep their heads in the same position when lying down, which can cause flattening. Most babies with flat head syndrome also have some degree of torticollis, so stretches at home and physical therapy are usually part of treatment.
When should I be concerned about my baby's head shape?
You should be concerned if the back of the baby's head is flatter on one side, the baby has less hair on that part of the head, or when looking down at the baby's head, the ear on the flattened side may look pushed forward. In severe cases, the forehead might bulge on the side opposite from the flattening and may look uneven.
Do helmets work for treating flat head syndrome?
A doctor may prescribe a helmet for flat head syndrome. The helmet is designed to fit a baby loosely where the head is flat and tightly where it is round. Helmets make the head rounder quicker than time and normal growth. However, on average, babies who get helmets and those who don't have the same results after a couple years. Talk to your doctor about whether a helmet could help your baby.
How long does it take for flat head syndrome to improve?
Flat head syndrome improves with time and natural growth. As babies grow, they begin to change position themselves during sleep, so their heads aren't in the same position. When babies can sit on their own, a flat spot usually won't get any worse. Then, over months and years, as the skull grows, the flattening will improve, even in severe cases.
Are premature babies more likely to have flat head syndrome?
Yes, premature babies are more likely to have a flattened head. Their skulls are softer than those of full-term babies. They also spend a lot of time on their backs without being moved or picked up because of their medical needs, such as a stay in the neonatal intensive care unit (NICU).
Will my baby's flat head affect their appearance as they grow up?
As hair grows in over the first few years, the flat spot often becomes less noticeable as well. Most cases of flat head syndrome improve significantly with time and natural growth. Even in severe cases, the flattening will improve over months and years as the skull grows. The condition is primarily cosmetic and doesn't affect brain development or long-term health.