Plagiocephaly and Baby Flat Head Syndrome

Noticing a flat spot on your baby’s head can feel concerning, especially for first-time parents. Plagiocephaly, commonly called baby flat head syndrome, happens when repeated pressure on one area of a baby’s soft skull causes flattening. The good news is that plagiocephaly is very common and often improves with early intervention and positioning changes.¹

While some babies may eventually need helmet therapy, many mild cases improve with supervised tummy time, repositioning, and reducing pressure on the flattened area. Here’s what parents should know about plagiocephaly, what causes it, treatment options, and ways to help prevent flat spots from developing.

Your pediatrician can help determine whether your baby’s head shape changes are mild or may require additional evaluation.

What Is Plagiocephaly?

Plagiocephaly, often called positional plagiocephaly, occurs from a baby’s positioning in utero or after birth.¹ Because newborn babies have a malleable skull (meaning they have soft spots and bones that are not entirely fused yet), the skull can form into shapes other than round fairly easily.⁵

The purpose of the malleable skull is to allow for growth and to allow the baby to pass through the birth canal.^5,6 Your baby’s brain will double in weight in one year due to new synapses between neurons if they get plenty of stimulation.⁷ The unfused skull allows for this growth and a misshapen head when too much pressure is on one specific area.^1,2

The best way to assess the shape of your baby’s head if you’re concerned about a flat spot or baby flat head is to look at it from the top. Fortunately, plagiocephaly typically does not affect your baby’s brain development, as the brain is well-protected.⁵

Additionally, don’t be alarmed if their head is the shape of a cone when they are born vaginally. It is not plagiocephaly — instead, it is due to the pressure of the birth canal. This typically resolves within a few days or, at most, a few weeks.⁸

Related: Baby Milestones Month by Month: Your Baby’s First Year Guide

What Is Torticollis?

Babies with plagiocephaly may have a secondary condition called torticollis. This is a tightness on one side of your baby’s neck muscles.⁵ The position in utero often causes this.⁹

You can identify torticollis by noting how your baby turns their head. Do they always look in one direction? Does it seem like their neck is stiff and uncomfortable if you try to turn their head the other way?

Torticollis can contribute significantly to plagiocephaly.⁹ If you suspect it, you should let your baby’s healthcare provider know immediately because they may require physical or occupational therapy to release those tight muscles and work on positioning.⁶

Torticollis is one of the common causes of baby flat head, especially when a baby consistently turns their head to one side.

Related: What To Do If Your Baby Has Torticollis

Risk Factors for Plagiocephaly and Flat Head Syndrome

Some babies are more likely to develop plagiocephaly because of positioning, muscle tightness, or extended time spent lying in one position.

Premature babies are at higher risk for plagiocephaly because they often spend extended periods in one position in an incubator in the neonatal intensive care unit (NICU).^1,5,10 Additionally, in 1992, the American Academy of Pediatrics recommended that all babies sleep on their backs in the “Back to Sleep Campaign” to decrease the chance of sudden infant death syndrome (SIDS).^3,11,12 While the incidence of SIDS decreased, the incidence of positional plagiocephaly dramatically increased.^3,12

How Plagiocephaly Is Treated

Treatment recommendations often depend on your baby’s age and the severity of the flat spot.

Once your child can sit and stand, the prolonged pressure on their head is mostly eliminated. Their head will naturally become rounder, and their hair will cover any remaining flat spots. A memory foam pillow may reduce pressure on the skull in preterm and very young babies.¹³ (The pillow should not be used for sleep. Baby should be monitored at all times while using any pillow.) Another option is the Tortle, a hat that prevents babies from turning their heads, so pressure isn’t on the flattened part of the skull.

If changing your baby’s positioning and using the memory foam pillow or Tortle is not effective, and your childcare provider diagnoses your baby with plagiocephaly, they may refer your baby to a pediatric neurosurgeon.

The pediatric neurosurgeon will thoroughly evaluate your child, take specific measurements, and possibly refer your child to an orthotist.⁴ The orthotist will probably make a mold of your child’s head.

Not every baby with plagiocephaly will need helmet therapy.

From this, a helmet is fabricated and designed to achieve symmetry for your baby’s head.^2,5

According to the American Association of Neurological Surgeons, helmets are most effective between 3 and 6 months of age.⁵

However, correction is still possible for up to 18 months, which may simply require a longer treatment process.⁸ It will be recommended that your baby always wear the helmet, removing it only for baths.⁵

How to Prevent Plagiocephaly and Baby Flat Head Syndrome

Daily positioning habits can play an important role in preventing or improving flat spots on your baby’s head.²

1. Tummy Time

Allow your baby lots of supervised tummy time from the day they are born. Supervised tummy time helps build strength in your baby’s neck and shoulder muscles.^5,9 We recommend five minutes several times per day for newborns and 20-30 minutes a few times per day for 3-month-old babies.¹⁴ Babies should still always be placed on their backs for sleep, even while working to prevent plagiocephaly.^11,12

Related: How to Make Tummy Time Easier and More Enjoyable for Your Baby

2. Babywearing

Carry your baby in vertical baby carriers and slings. This relieves pressure from baby’s head and has the added benefit of keeping them close to you.⁸ Babywearing can help them with bonding, learning a new language, and processing the world from a vertical position, building balance and equilibrium.¹⁵

Related: Benefits of Babywearing for Mom and Baby

3. Upright Positioning

Another way to help prevent plagiocephaly is to hold your baby upright on your shoulder whenever possible. This includes holding baby upright when cuddling them. Like babywearing, holding your little one upright helps relieve pressure on their head.^2,5,6

4. Alternate Head Positions

Move baby’s mobile from one side of the crib to the other so they are gazing up at it from alternate directions, changing the position of their head. When holding and feeding your baby, try to alternate between positions from right to left so the pressure on their head is symmetrical. This is also great for your baby’s developing vision.¹⁶

Rearrange your baby’s room or the position of their crib or bassinet so they are looking in a different direction. Babies often look toward light sources or doorways as they anticipate your arrival.

Related: How to Organize a Beautiful and Functional Nursery

5. Avoid Containers

Try to eliminate time spent in baby swings, car seats, and bouncy seats. Instead, hold your baby or use a baby carrier whenever possible. You should also try to leave the car seat in the car.

Plagiocephaly and baby flat head syndrome are very common during infancy, especially while babies spend so much time lying on their backs for safe sleep. Fortunately, many cases improve with simple positioning changes, tummy time, and early intervention. If you notice a flat spot forming or have concerns about your baby’s head shape, talk with your child’s healthcare provider for guidance and support.