Flat head syndrome (Plagiocephaly)

What is flat head syndrome?

Flat head syndrome (also known as positional plagiocephaly) is a flat spot/patch on your baby’s head.

What causes flat head syndrome?

The most common cause of a flattened head is the 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 their in infant car seats, carriers, strollers, swings, and bouncy seats.

Babies that are born premature are more likely to develop flat head syndrome. 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).

Flat head syndrome can start before birth if there's pressure on the baby's skull from the mother's pelvis or a twin. It is common for twins or babies from multiple births to be born with heads that have some flat spots.

It takes a lot of energy and strength for babies to turn their heads. So those with severe flattening on one side tend to stay on that side, their necks become stiff and their neck muscles tighten from lack of use (torticollis). 

What should I look out for?

Flat head syndrome usually is easy for parents to notice:

  • There is a distinctive flat patch on the babies head.
  • The baby usually has less hair on that part of the head.
  • When looking down at the baby's head, the ear on the flattened side may look pushed forward.
  • In rare but severe cases, the forehead might bulge on the side opposite from the flattening and may look uneven. If torticollis is the cause, the neck, jaw, and face also might be uneven. 

How is flat head syndrome diagnosed?

Your GP should be able to diagnose flat head syndrome by looking at the baby's head. To check for torticollis, the doctor may watch how a baby moves the head and neck. Further tests are usually not needed. 

How is flat head syndrome treated?

Caregivers should always place babies on their back to sleep this helps to prevent SIDS, even with the possibility of flat head syndrome. Avoiding swings, car seats, bouncy chairs, and other devices is safest for sleep and helps to make sure that babies can move their head freely.

So, what can you do to prevent and treat flat head syndrome? Simple practices like changing a baby's sleep position, holding your baby, and providing lots of "tummy time" can help it go away. Try these tips:

Use a pillow during the day that is designed to prevent and treat flat head syndrome. Our perfect head pillow is ergonomically designed to distribute the pressure of your baby’s skull evenly across the pillow to promote healthy growth of the head and cervical spine. Shop here

  • Practice tummy time. Provide plenty of supervised time for your baby to lie on their tummy while awake during the day. This allows your baby’s head time to move freely without pressure on one particular spot.
  • Hold your baby more often. Limit the time your child spends lying on his/her back or with the head resting against a flat surface.
  • Change the head position while your baby sleeps. Change the position of your baby's head (from left to right, right to left) when your baby is sleeping on the back. Even if your baby moves around during the night, place your child with the rounded side of the head touching the mattress and the flattened side facing up. Don't use wedge pillows or other devices to keep your baby in one position unless they are supervised.

Most babies with flat head syndrome also have some degree of torticollis. A home exercise program is usually part of treatment. A physio therapist can teach you exercises to do with your baby involving stretching. Most moves involve stretching the neck to the side opposite the tilt. In time, the neck muscles will get longer, and the neck will straighten itself out. The exercises are simple but must be done correctly. In severe cases your GP can 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. In the helmet, the head can't grow where it is already round. So, it grows where it's flatter.

Helmets make the head rounder quicker than time and normal growth. On average, though, babies who get helmets and those who don't have the same results after a couple years. If you are worried talk to your GP about whether a helmet could help your baby. 

WIll my babies head always be flat?

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 and the flattening will improve, even in severe cases. As hair grows in over the first few years, the flat spot often becomes less noticeable as well.

Flat head syndrome doesn't affect a baby's brain growth. But having a stiff neck can slow early development. Physical therapy for torticollis should include a check of the baby's progress and extra exercises to treat any delays.