Flat head syndrome

Flat head syndrome is the development of a flat spot or change in the shape of your baby’s head, also known as positional plagiocephaly. A baby’s skull is made up of soft bones that grow together and harden over time — this process usually takes about 12 to 24 months. This process also allows for a baby’s brain to grow. If a baby spends a lot of time on her back (or consistently lies on one side or the other), a flat spot can form on her head. Little or no hair may grow on those spots. Once the baby starts to roll over, sit up, crawl, and walk, the flat spot will usually disappear and hair will grow back. In rare cases, the baby’s head may become severely misshapen. 

How is flat head syndrome diagnosed?

Doctors usually diagnose the condition by simply looking at a child’s head and monitoring any changes in shape over time. If repositioning the child's head during sleep helps to improve the skull shape over time, the problem is likely due to flat head syndrome. If the doctor notices no improvement in the shape of the skull over time, the doctor may look into other conditions, such as craniosynostosis which is uncommon, but a more serious cause of baby head shape change.

How is flat head syndrome treated?

For children with severe flat head syndrome in which repositioning for 2-3 months doesn't help, doctors may prescribe a custom-molded helmet or head band. Your pediatrician may also refer your baby for early intervention services and an evaluation from a pediatric physical therapist. The therapist will evaluate your baby for any delayed motor skills that could be caused by poor head and neck control, and may recommend stretching and positioning exercises for your baby to do at home.

How can I prevent flat head syndrome?

There are a few habits parents can adopt to aid in healthy skull development. These simple practices are most fruitful when started early in baby's life and can also help stop flat head syndrome from progressing when flattening is noticed early. 
  • Practice skin-to-skin care. Hold your baby more often to reduce the amount of time she spends lying on her back or resting her head on a flat surface such as cars seats and strollers. More skin to skin time will reduce the overall pressure on her head.
  • Alternate positions in the crib. Alternate which direction you place your baby in her crib. Babies tend to turn their heads toward an object of interest, such as a mobile or a light source; by alternating her positioning, she may naturally change the direction of her head without you having to force her head to rest on any particular side.
  • Alternate arms. Parents often hold their babies on the same side as their dominant hand without even realizing it. Try to switch sides more often when holding or feeding your baby.
  • Increase tummy time. Putting your baby on her tummy when she is awake can help to reduce your baby’s risk for flat spots and also strengthen the muscles needed for crawling and sitting. Because the risk of SIDS is greater when babies are on their stomachs, parents should never leave a baby alone during tummy time. If you need to leave your baby alone, even for a minute, turn her onto her back until you return.
Even if your baby has been diagnosed with flat head syndrome, continue putting her to sleep on her back during naps and at night. The American Academy of Pediatrics (AAP) recommends placing infants on their backs to sleep to greatly decrease the risk for Sudden Infant Death Syndrome (SIDS). 

To learn more about positional plagiocephaly, see the AAP's overview of new guidelines on positioning and physical therapy.

To learn more about positional plagiocephaly, see the AAP guidelines on Prevention and Management of Positional Skull Deformities in Infants.

Last updated August 17, 2020

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