Flat spots on a baby’s head, medically known as positional plagiocephaly or brachycephaly, are a frequent concern for new parents. These head shape variations are observed in the first few months of life. While often a cosmetic issue, understanding their nature and how to address them provides reassurance and actionable steps.
Understanding Flat Spots
A flat spot on a baby’s head results from external pressure applied to the soft, malleable skull bones. This phenomenon is broadly termed flat head syndrome. Positional plagiocephaly specifically describes a flattening on one side of the back of the head, often causing the ear on that side to appear pushed forward. Brachycephaly, on the other hand, involves a flattening across the entire back of the head, making the head appear wider than it is long.
These conditions arise because infants spend time lying on their backs, a position recommended for safe sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS). Other factors include a baby’s head preference, prematurity (due to softer skulls), or pressure within the womb (especially in multiple pregnancies). Torticollis, a condition involving tight neck muscles, can also lead to flat spots by limiting a baby’s ability to turn their head freely. Positional flat spots are considered a cosmetic issue and do not impact brain development.
Home-Based Correction Strategies
Addressing an existing flat spot begins with consistent home strategies. Increasing supervised tummy time is a recommended approach, as it takes pressure off the back of the head and strengthens neck, shoulder, and arm muscles. Begin with short sessions of 3-5 minutes a few times daily, gradually increasing to 15-30 minutes by two months of age, and up to an hour by three months.
Repositioning the baby’s head during sleep helps distribute pressure. Always maintain the “Back to Sleep” recommendation while gently turning the baby’s head to alternate sides each time they are laid down. Varying the baby’s position in the crib, such as alternating which end their head points, encourages them to look in different directions.
Throughout the day, parents can vary how they hold their baby to relieve pressure on the flattened area. This includes switching arms during feeding and carrying the baby in different orientations. Limiting time in carriers, swings, and bouncers is beneficial, as these devices keep the head fixed, contributing to flattening.
When to Seek Professional Guidance
While many flat spots improve with home-based strategies, professional guidance may be necessary. Consult a pediatrician if the flat spot appears severe, is not improving with consistent home efforts, or for concerns about underlying conditions like torticollis. Early intervention is beneficial, as a baby’s skull is most malleable in the first six months of life.
For moderate to severe cases, if home remedies are insufficient, a cranial orthosis, commonly known as helmet therapy, might be recommended. These custom-fitted helmets gently redirect skull growth by applying pressure to rounded areas and allowing flat areas to expand. Helmet therapy is typically considered for babies between 3 and 12 months old and is usually worn for 23 hours a day over several months. If torticollis is present, physical therapy may be recommended, involving exercises and stretches to improve neck flexibility and range of motion.
Preventing Flat Spots
Proactive measures can help prevent flat spots from developing. Consistent supervised tummy time is important for prevention, strengthening neck and shoulder muscles while reducing pressure on the back of the head. This practice should be incorporated into the baby’s daily routine from birth.
Regularly varying the baby’s head position when awake and supervised helps distribute pressure evenly. Parents can encourage active head movement by positioning toys or themselves to prompt the baby to look in different directions. Alternating which arm is used for feeding and how the baby is held throughout the day also promotes varied head positions. Limiting time babies spend in car seats, swings, bouncers, and other devices that restrict head movement is important for prevention. Encouraging supervised floor play and interaction allows for natural head movements and overall motor development.