Positional head flattening, a flat spot on an infant’s head, is a frequent concern for parents, especially since the recommendation to place babies on their backs for sleep to reduce the risk of Sudden Infant Syndrome (SIDS). This common condition is generally correctable because a young baby’s skull is soft and highly moldable. Early intervention using simple, non-invasive home remedies can often effectively reshape the head without the need for medical devices like a helmet. Success relies on consistently relieving pressure from the flattened area, allowing the skull’s natural growth to round out the shape. This approach focuses on repositioning and strengthening the neck muscles to encourage balanced head movement.
What Causes Positional Head Flattening
Positional head flattening occurs because a baby’s flexible skull bones are susceptible to external pressure. The two main types are plagiocephaly, an asymmetrical flattening on one side of the back of the head, and brachycephaly, a symmetrical, wide flattening across the entire back of the head. These conditions are cosmetic and positional, arising from repeatedly resting the head in the same spot.
This positional flattening is distinct from craniosynostosis, a much rarer and more serious condition. Craniosynostosis involves the premature fusion of one or more growth plates, or sutures, between the skull bones. Unlike positional flattening, craniosynostosis restricts brain growth and typically requires surgical correction. A doctor can usually differentiate between the two by a physical examination.
Non-Helmet Techniques for Head Repositioning
The first line of defense against positional head flattening involves environmental adjustments to relieve static pressure. This counter-positioning strategically encourages the infant to turn their head away from the flat spot. The goal is to maximize the time the baby spends with the fullest part of their head resting against a surface.
Managing the time a baby spends in “containers” is important, as these devices keep the head static. Parents should limit the use of car seats, swings, and bouncy seats to only when necessary for transport or short periods of supervision. While the baby is awake, using a play mat on the floor should be prioritized over a reclined seat.
Several techniques can be used during sleep and feeding to encourage head rotation:
- Crib positioning can be manipulated by placing the baby at the opposite end of the crib each night. This prompts them to look in the opposite direction toward visual stimuli, such as a parent or window.
- During bottle-feeding, switch the arm that cradles the baby halfway through the feeding to encourage them to look in the opposite direction.
- When carrying the baby upright, constantly change the hip used to support them to prevent favoring one side.
Improving Neck Strength and Motor Skills
Positional flattening is often associated with a preference to turn the head to one side, which may be related to mild muscle tightness known as torticollis. Addressing this underlying muscular preference is important for long-term correction, requiring a focus on dynamic movement and muscle strengthening activities.
Tummy Time is the most effective non-helmet intervention, as it completely removes pressure from the back of the head while strengthening the neck and upper body muscles. Start Tummy Time early, aiming for short sessions of three to five minutes, two to three times a day. The goal is to gradually increase the total duration to 60 to 90 minutes spread throughout the day by four months of age.
Simple exercises can increase the baby’s range of motion and encourage turning the head equally in both directions. Use engaging toys, lights, or sounds to prompt the baby to track an object over their shoulder, especially toward the non-preferred side. This helps stretch the neck muscles and is more beneficial than passive stretching for mild cases.
Specific carrying techniques can also promote head lifting and turning. The “football hold,” where the baby is carried face-down with their head supported by the parent’s hand, encourages the baby to lift their head against gravity. Vertical carrying, such as over the shoulder, allows the baby to practice head control and takes pressure off the flattened area.
When Home Efforts Are Not Enough
Repositioning and strengthening techniques are highly effective for mild to moderate flattening, but parents must monitor progress and be aware of the time window for correction. The skull is most malleable during the first few months of life, with the highest potential for correction occurring before six months of age. After eight to ten months, the rate of skull growth slows significantly, making non-helmet interventions less effective.
Parents should watch for signs of increasing severity that indicate a need for professional evaluation. These signs include the ear on the flattened side shifting forward, or noticeable facial asymmetry, such as one eye appearing smaller or a forehead bulge. These features suggest a more significant asymmetry that may not fully self-correct.
If the flattening is moderate to severe, or if no improvement is observed after two months of consistent repositioning and Tummy Time, a consultation with a specialist is recommended. The pediatrician may refer the family to a physical therapist for evaluation of torticollis or to a craniofacial specialist or orthotist. These experts can accurately measure the head shape and determine if a cranial molding helmet is necessary to achieve full correction.