Flat Head Syndrome (Plagiocephaly) in Babies

Underneath that soft, fuzzy surface, an infant's skull is like a set of shifting puzzle pieces that allow his head to grow. These malleable plates are great at protecting your little one's developing brain, but they can flatten when you put your baby down on his back (though some babies are born with mishapen heads from their position in the womb or trip through the birth canal).

Don't be alarmed. You're absolutely right to have your baby sleep face up, to reduce the risk of sudden infant death syndrome (SIDS). And those flattened spots will likely eventually go away, as long as you give your baby plenty of supervised tummy time during the day, and they tend to improve as kids begin to sit up on their own. Here's what you need to know about flat head syndrome, or positional plagiocephaly.

What is plagiocephaly (aka flat head syndrome)?

Plagiocephaly, or flat head syndrome, is when a baby's head is flat on one side. It's linked to a baby sleeping exclusively on his back as well as spending a lot of time lying in a rocker, car seat or swing. As distressing as this can be to a new parent, a flat head is treatable and doesn’t mean your baby is in pain or will have any developmental delays.

In fact, the increasing number of flat-headed babies is a sign that parents are keeping their little ones safe. The American Academy of Pediatrics (AAP) reports that pediatricians have seen a growing incidence of positional plagiocephaly since the group began recommending that infants sleep on their backs to reduce the risk of SIDS. One study found that nearly half of all infants aged 7 to 12 weeks had plagiocephaly. Of those, 78 percent had a mild form.

Symptoms of plagiocephaly

Symptoms of plagiocephaly are visible to the eye, where a baby's head is flat on one side (often the back of the head), pointy or even parallelogram-shaped. Babies with these symptoms generally don't have learning delays or any other adverse health effects. Sometimes severe plagiocephaly also presents as facial flatness or changes in the position of a baby's ears.

When to call the doctor

If you notice your baby is developing flat head syndrome, it's always a good idea to check in with your pediatrician. He or she will rule out craniosynostosis, a rare genetic defect that causes the plates on a baby's skull to fuse prematurely.

Your pediatrician will monitor your baby's growth and development (including his head shape), help you make sure he gets plenty of tummy time, and offer other tips to reverse the flattening (called "positioning therapy"). In severe cases, your doctor may recommend a special helmet to help your baby's head grow back into a rounder shape, although these can be expensive and uncomfortable for your child.

What’s the treatment for a flat head baby?

Reducing pressure on the skull is the most common treatment for flat head syndrome. Tummy time is the most effective and easiest approach. It involves placing a blanket or towel on the floor and putting your baby on his stomach while he's awake for a few minutes at a time, ideally for at least 30 minutes total every day.

As your baby bobs and weaves to try to lift his head, he's developing stronger neck and shoulder muscles. He's also giving the back of his head a break from the pressure of lying flat, which can prevent or help reverse plagiocephaly.

Never leave your baby unsupervised during tummy time. Even if he can’t crawl away yet, you want to watch closely to make sure he doesn’t tire and bump his face on the floor.

Another treatment if your baby has a flatter head on one side or the other is to switch positions while he sleeps. One way is to simply move his head from one end of the crib to another on alternate rest periods. As he naturally pivots his eyes towards the light or any movement in the room, opposite sides of his head will get a break.

If your baby's head shape doesn't respond to these adjustments, your pediatrician may recommend a special helmet to help your baby's skull grow more evenly.

In very rare cases, your doctor may discuss surgery as an option to reshape a severely misshapen skull.

What causes baby flat head syndrome?

Babies' heads are very malleable, so anything that puts pressure on the skull can cause flat head syndrome. 

If your baby is born with a flat or misshapen skull, it's known as molding. This common condition usually resolves on its own within a few days, although your doctor will note it on your baby's medical record for follow-up. A few common reasons for a misshapen head at birth include:

• Pressure from prolonged pressure in the uterus (like twins whose heads are positioned pressed together, or babies who are large for their gestational age)
• Pressure put on the skull during the trip through the birth canal
• Assisted-delivery devices such as vacuums or forceps, which can mold the skull
• Torticollis, a fairly common condition characterized by stiff, tight neck muscles in your baby

Other causes of a flat head that occur after birth include:

• Putting baby to sleep face-up on a firm mattress, which puts pressure on the back of the head
• Laying baby flat in a car seat or swing for long periods of time

Can you prevent plagiocephaly?

You can prevent flat head syndrome at home by having baby spend as much time as possible off of his back. This includes:

• Giving your baby at least 30 minutes of supervised tummy time every day when he's awake, starting as soon as he comes home from the hospital 
• Putting your baby to sleep on his back at alternate ends of the crib
• Carrying him more often
• Sitting him upright rather than laying him down when bottle-feeding

Parents concerned about head shape should make sure their first priority is to prevent SIDS and other sleep disorders. Back-sleeping may increase the risk of flat head syndrome but it reduces the risk of SIDS, so it's worth the trade-off.

When does flat head syndrome go away?

Flat head syndrome is most common between the ages of 6 weeks and 2 months old, and almost always resolve completely by age 2, particularly if parents and caregivers regularly work on varying baby's positions when he's awake.

Flat head syndrome can be disconcerting, especially for new parents, but it rarely causes any harm to your baby and usually remedies itself within a few months. Don't let the sight of a flat or pointy head detract from the joy of the first few months of babyhood, because they'll be gone before you know it.