Parents concerned about an infant’s head shape, often called “flat head syndrome,” should know that non-invasive, at-home solutions are highly effective, especially when implemented early. The flattening is typically a positional issue that develops after birth, not a problem with brain development. Since the skull bones are soft and pliable during the first several months of life, varying the pressure points on the head is the most successful strategy. This article details active repositioning techniques that can help correct the head shape without a medical helmet.
Understanding Positional Head Flattening
The term “flat head syndrome” describes two main types of deformational shaping caused by external pressure on the soft infant skull. Plagiocephaly involves an asymmetrical flattening on one side of the back of the head, sometimes causing the ear and forehead on the affected side to appear pushed forward. Brachycephaly, by contrast, is a symmetrical flattening across the entire back of the head, often resulting in a head that looks disproportionately wide when viewed from above.
The primary cause for both conditions is the increased time infants spend lying on their backs, a practice recommended to reduce the risk of Sudden Infant Death Syndrome (SIDS). This constant pressure on the same area of the skull leads to gradual flattening. A tight neck muscle condition known as Torticollis can also contribute by causing the baby to prefer turning their head to only one side, concentrating pressure on that area. While most cases are positional, a pediatrician must rule out Craniosynostosis, a rare condition where skull plates fuse prematurely and restrict brain growth, requiring surgical intervention.
Active Repositioning Techniques
The most effective non-helmet strategy involves actively repositioning the infant to relieve pressure on the flattened area. Tummy Time is a primary method, as it removes all pressure from the back of the head while strengthening neck and upper body muscles. Sessions should begin early, starting with short periods of three to five minutes, two or three times a day. By two to three months of age, babies should work toward a cumulative total of 15 to 30 minutes of supervised Tummy Time daily.
Parents should also implement strategic repositioning while the baby is sleeping, always adhering to safe sleep guidelines by placing the baby on their back. For Plagiocephaly, alternate the direction the baby’s head is placed in the crib on successive nights. Since babies naturally turn their head toward visual stimulation, changing the orientation encourages them to turn toward the non-flattened side.
Varying how the baby is held and carried throughout the day is highly effective. When feeding or carrying the infant, alternate the arm used to ensure the head rests on different sides, distributing pressure evenly. Parents should limit the time spent in devices that place a constant load on the back of the head, such as car seats, swings, and bouncers. Limiting these “containers” to necessary travel or short periods, and encouraging more time being held upright or engaging in floor play, helps the head naturally round out.
Assessing Severity and Professional Treatment Options
If repositioning efforts are not yielding improvement, or if the flattening appears severe, parents should consult their pediatrician. The first few months of life, when the skull is growing most rapidly, are the ideal window for non-invasive treatment. Improvement should generally be visible by four to six months of age.
If the baby has difficulty turning their head, a referral for physical therapy (PT) may be recommended to address Torticollis. PT involves specific exercises designed to loosen tight neck muscles, allowing the infant full range of motion to naturally move their head off the flat spot. Helmet therapy, or cranial orthosis, is reserved for moderate to severe cases where active repositioning and physical therapy have not been successful.
A helmet works by providing a custom-fit shell that gently holds the flattened areas while allowing the head to grow into a rounded shape. This treatment must be started within a specific time frame, generally between four and eight months of age, when the skull is still highly malleable. It is considered the next step when conservative methods alone are insufficient to achieve the desired correction.