Is My Baby’s Flat Head Normal? What To Know About Flat Head Syndrome

You’re changing your baby or maybe someone else is holding them and suddenly you notice it… one side of their head looks flatter. This can come with a rush of thoughts: am I seeing this right? Is this normal? Why is this happening? Am I doing something wrong? Should I call the pediatrician? 

You’re right to be concerned, but I’d like to encourage you not to panic or immediately spiral into calling the pediatrician. This is more of a “I noticed it, I need to address it, but it’s not medically urgent” situation versus a “worry and get on the phone right away because it’s urgent and get into the see the physician” situation.

What’s “normal” with a baby’s head vs what’s common

Baby’s heads are soft, much softer than people realize. Most people understand that it needs to be soft for baby to come out of the birth canal, but it remains soft after birth. This means the head is malleable and will start to change shape when persistent forces are placed upon it. The most common things I see causing baby’s heads to change shape are related to spending an extended amount of time in one or all of these places:

• Crib or bassinet

• Bouncer

• Swing

• Cradled face up in parents’ arms

  
  

These changes are very common in this day and age. And to further put this into perspective, I’ve been a pediatric physical therapist for 10 years- all three of my children have had flat heads at some point in their newborn months. It’s a very common occurrence. The important thing is to understand why it’s happening and what needs to be done about it. 

What is plagiocephaly (aka flat head syndrome)?

Plagiocephaly is the term used to describe when a skull is flattened on one side. This flattening typically occurs toward the back side of the head. Depending on the severity of the flattening, we can also see a shifting of the forehead, face, and ear on the side opposite of the flattening. These areas can shift forward and start to protrude in response to the flattening occurring on the back side of the head. 

There is another term that can be used to describe flattening to the back of the head, and this is called brachycephaly. This type of flattening is across the entire back side of the head rather than off to one side. We will see the head of a baby with brachycephaly start to have a widening of the skull to either side, ears can become more prominent, and they will lose the little bump at the base of their skull making the back of their head look continuous with their neck. 

Why do these changes happen?

The primary reason that these changes occur is because of prolonged pressure to the baby’s head. When the pressure is persistently on the same spot, it will rapidly start to cause changes to baby’s skull shape. Common reasons for pressure are:

• Back sleeping

• Torticollis (which pulls baby to one side or the other)

• Time spent in containers (swings, car seats, bouncers)

• Parent carrying habits

The question every mom is asking: Will my baby's flat head fix itself?

This is very dependent on the severity of the flattening and what parents and caregivers are already doing in their daily routine with baby. When babies come into my clinic with head shape concerns, I will always do measurements to determine the severity. The more severe, the less likely it is to resolve without intervention. When head flattening becomes more severe, it’s been my clinical experience that these babies also tend to: 

• Have a head position preference or torticollis to go along with it

• Struggle with tummy time

• Have reflux, constipation, or colic symptoms

When the flattening is less severe, I will acknowledge that it can go away on its own. In fact, this is often what parents are told by their pediatricians- it will go away on its own, it will fix itself. However, your health care provider shouldn’t be telling you this without performing head measurements that go beyond just taking your baby’s head circumference. In our clinic, we measure various dimensions of your baby’s head and then calculate the severity of the head shape changes in relation to their age. Knowing the severity of the changes directly affects what needs to be done to fix the issue. 

What you can do right now if your baby has a flat spot

The first thing to do is assess your baby’s daily routine. Ask yourself the following questions:

• What position does baby sleep in and is their head always turned the same direction?

• Does baby spend more than an hour a day in a container? (car seat, swing, bouncer)

• Does baby get tummy time during the day and do they tolerate it well?

• Does my baby seem stuck with their head in only one position even if I try to help them turn it?

  
  

Based on the answers to those questions you can start doing the following:

• Change which end of the bassinet or crib your baby lays on. Babies will often turn their heads towards their parents, so putting their head at the opposite end can encourage them to turn the other way.

• Limit time in containers. There is no hard and fast time rule here, but I like to encourage parents to hold their babies or put them on the floor or in a safe play space more than they set them down in a container. Baby wearing is also a great way to hold your baby while having your hands free. 

• Increase the amount of tummy time your baby is doing. One common misconception parents have is that tummy time needs to be flat on the floor. This is not true. Tummy time can be done on a parent’s reclined chest, propped up on a rolled up towel or boppy pillow, and while being carried tummy down in a parent’s arms. 

• Avoid holding them in a cradle position in the same arm all of the time. Babies can be carried up at your shoulder or tummy down in your arms. A variety of positions is good for them on multiple levels beyond just their head shape. That doesn’t mean you can never hold your baby in a cradle position, but it is important to be aware of how the pressure of your arm to the back of their head can perpetuate a flat spot. Even something as simple as changing arms periodically can make a massive difference. 

If something feels off, it’s worth getting it checked out. At our Waukesha clinic, we are always offering free head shape screenings. We do this so parents can understand exactly how severe their child’s flat spot is and we help them make a plan to address it. If you are not local to the area, I would encourage you to find a provider who is able to take head shape measurements. This could be a physical or occupational therapist, or you may need to seek out a company who creates infant helmets in your area to get a good measurement. 

Baby having a flat spot measured with a craniometer

FAQ

Is head shape just a cosmetic issue?

Absolutely not, head shape is not just a cosmetic issue. Flat spots can cause changes to the face that can impact vision, jaw function, and symmetrical muscle development which will have lifelong impacts on a child. It is also important to note that heads that are significantly altered in shape will not be able to receive the full benefit of protection of helmets and other protective head gear, placing them at higher risk from common childhood activities like riding a bike or roller blading should they have a head impact. 

What do I do if my baby’s flat head is severe? 

Physical therapy may be required, or even a helmet. If we can start intervention early for flat spots, even more significant ones, we can often see a resolution with therapy and not have to resort to a helmet. However, once a baby reaches around 4 months of age, a more significant flat spot is more likely to require the use of a helmet to correct.

Where can I get a head shape evaluation for my baby?

In the Waukesha and Milwaukee areas, you can get a head shape evaluation for free at our clinic. If you are not local to southeast Wisconsin, you can check with physical and occupational therapy practices in your area if your pediatrician is unable to provide you with measurements beyond head circumference. You can also contact companies that make infant helmets such as Cranial Technologies and seek an assessment there. 

Dr. Sabrina Thorpe is a Doctor of Physical Therapy with a decade of clinic experience. She specializes in treating pregnant and postpartum women and their infants at Foundation Physical Therapy in Waukesha, WI.