A flat spot on an infant’s head, known as positional plagiocephaly or brachycephaly, is a common and highly treatable concern for parents. This head shape asymmetry results from external pressure. The flattened area does not affect the baby’s brain or cognitive development. This guide provides practical steps for at-home correction and clarifies when professional medical evaluation is necessary.
Why Flat Spots Occur
A baby’s skull is made of soft, pliable bony plates that are not yet fused, allowing for rapid brain growth. This malleability makes the head susceptible to flattening when constant pressure is applied to the same spot. The primary factor contributing to flat spots is the “Back to Sleep” campaign, which advises placing infants on their backs to reduce the risk of SIDS.
While back sleeping is the safest position, the time spent supine means gravity exerts prolonged pressure on the head. Positional plagiocephaly is an asymmetrical flattening on one side, sometimes causing the ear to shift forward. Brachycephaly is a symmetrical flattening across the entire back of the head, leading to a wider head shape.
The flatness is usually due to external pressure, known as deformational plagiocephaly. A less common cause is craniosynostosis, where the skull plates prematurely fuse, requiring specialized medical assessment. Positional plagiocephaly can also be exacerbated by torticollis, a condition involving tight neck muscles that limit the baby’s ability to turn their head, causing them to favor one resting position.
At-Home Repositioning Strategies
Repositioning techniques are the first-line treatment for mild to moderate flattening, focusing on relieving pressure during the baby’s waking hours. The goal is to encourage the head to rest on non-flattened areas, allowing the skull to reshape as the brain grows. These strategies are most effective when started early, ideally before the baby is four to six months old.
Tummy time is the most important activity, as it completely removes pressure from the back of the head. It also strengthens the neck and upper body muscles needed for developmental milestones. Supervised tummy time should be practiced frequently throughout the day, starting with short intervals and gradually increasing to 20 to 30 minutes daily. Encourage the baby to lift and turn their head in different directions using toys or your face.
Changing the orientation of the baby in the crib encourages them to turn their head away from the flattened side toward visual stimulation. Alternating the end of the crib where the baby’s head is placed ensures the baby looks out into the room from a different angle each time. Always place the baby on their back for sleep, avoiding the use of pillows or positioning devices in the crib.
Limiting the time spent in fixed-position devices is also important. Car seats, swings, bouncers, and infant carriers often keep the baby’s head resting on a hard surface. These devices should be used only for travel or when necessary, and time in them should be minimized while the baby is awake. Increase the time spent holding or carrying the baby, perhaps using a soft baby carrier, which keeps pressure off the back of the skull.
During feeding and carrying, consciously switch the side you hold the baby on to encourage equal head-turning. For a baby with a flat spot on one side, holding the baby with the flat spot facing upward helps take the pressure off that area. Utilizing this counter-positioning during all awake hours maximizes the time the head is free from resting pressure.
When Professional Medical Treatment is Needed
If at-home repositioning strategies do not produce noticeable improvement by four months old, or if the flattening is severe, professional medical treatment may be recommended. The pediatrician will assess the severity and determine if an underlying condition, such as torticollis, is contributing to the preferred head position.
If neck muscle tightness is identified, a referral to a pediatric physical therapist is often the next step. Physical therapy involves specific stretching and strengthening exercises designed to improve the baby’s neck range of motion. Addressing torticollis allows the baby to comfortably turn their head away from the flat spot and is a crucial part of the correction process.
For moderate to severe cases, a specialist may recommend a cranial orthosis, commonly called a helmet or band. This custom-fitted device applies gentle, persistent pressure to the rounder areas of the skull while leaving space over the flattened area for the head to grow. The helmet redirects the natural growth of the skull rather than squeezing the head.
The optimal time to begin helmet therapy is typically between four and six months of age when the skull is growing rapidly. Treatment can be effective up to 18 months. The helmet is generally worn for about 23 hours a day for an average duration of three to six months, depending on the child’s age and the severity of the condition.
Addressing Developmental Concerns
Positional plagiocephaly is overwhelmingly a cosmetic issue and does not affect the growth or function of the baby’s brain. The condition does not cause brain damage or impact a child’s intellectual ability. The brain will continue to grow normally regardless of the external head shape.
While the flat spot itself does not affect development, underlying causes like torticollis can sometimes be associated with a mild delay in motor skills due to limited neck movement. All babies with a flattened head should be screened for developmental milestones, and physical therapy may be recommended to ensure proper muscle development. Head shape correction often happens naturally once the baby achieves greater mobility, such as sitting up and crawling, which takes pressure off the back of the head.
Even in mild cases that are not actively treated, the flattening often becomes less noticeable as the baby grows and their hair fills in. For severe cases, professional intervention achieves a more symmetrical outcome. The long-term prognosis for a child with positional plagiocephaly is excellent, whether corrected at home or with a medical professional.