Positional head flatness, known medically as deformational plagiocephaly or brachycephaly, occurs when external pressures reshape a baby’s soft, rapidly growing skull. This article provides safe, non-medical approaches for caregivers, focusing on simple repositioning and gentle manual techniques intended to encourage a more rounded head shape. These at-home strategies are best suited for mild to moderate cases of flatness resulting from a positional preference.
Understanding Positional Flatness
A baby’s skull is soft and malleable, making it susceptible to changes in shape from consistent pressure during the first few months of life. Positional plagiocephaly is characterized by an asymmetrical flattening on one side of the back of the head. This flatness is often associated with torticollis, a condition involving neck muscle tightness that causes a baby to favor turning their head to one side.
Brachycephaly presents as a uniform flattening across the entire back of the head, causing the head to look wider than typical. Both conditions are primarily caused by prolonged time spent with the head resting against a flat surface, such as during sleep or in car seats and swings. While considered cosmetic and not affecting brain growth, they should be addressed early while the skull is still rapidly growing.
The Role of Repositioning and Tummy Time
The most effective non-manual intervention involves reducing the time a baby spends with pressure on the flattened area. Because infants must always be placed to sleep on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS), corrective efforts must occur during waking hours. This pressure relief is achieved through consistent repositioning and structured Tummy Time.
Tummy Time involves placing the baby on their stomach while awake and supervised, which is essential for strengthening neck, shoulder, and back muscles. Newborns can start with short sessions of just a few minutes, two or three times a day. As the baby grows stronger, the goal is to work up to a total of 20 to 30 minutes daily by the time they are about seven weeks old, which helps prevent flat spots and promotes motor skill development.
To encourage head turning away from the flat spot, caregivers should use counter-positioning strategies throughout the day. While the baby is on their back, try alternating the direction they face in the crib each night, which encourages them to look toward the activity in the room and put pressure on the rounder side of the head. During playtime, use toys and your voice to motivate the baby to turn their head toward the non-preferred side.
Limiting the use of restrictive baby equipment, often called “containers,” is another important step in repositioning therapy. Car seats, swings, and bouncers keep a baby’s head in a stationary position and should be used only for travel or short periods. Increasing the amount of time spent holding your baby upright or providing supervised side-lying play helps distribute pressure more evenly.
Gentle Manual Techniques for Head Shape
Manual techniques focus primarily on releasing tension in the neck muscles, particularly the sternocleidomastoid (SCM) muscle, which contributes to a head-turning preference and subsequent flatness. This tightness, known as torticollis, must be addressed to allow the baby to comfortably rest their head on the non-flattened side. The techniques described below are gentle range-of-motion exercises, not deep tissue massage applied directly to the skull.
To perform a gentle neck rotation stretch, lay your baby on their back on a flat surface. Stabilize the shoulder opposite the tight muscle with one hand; for example, stabilize the left shoulder if the baby favors turning right. Use your other hand to cup the baby’s head and slowly guide the chin toward the shoulder on the side of the tight muscle, holding the stretch for no longer than 30 seconds.
A lateral neck tilt stretch works to lengthen the SCM muscle by gently bending the head sideways. For a baby with tightness causing a tilt to the right, stabilize the right shoulder and gently guide the baby’s left ear toward their left shoulder. This should be done slowly and stopped immediately if the baby shows signs of discomfort or resistance.
Avoid applying any pressure or massage directly to the soft spots on a baby’s head, known as fontanelles. These stretches should be integrated into daily routines, performed several times a day, and only within the baby’s tolerance; never force the movement. These gentle movements help improve the full range of motion, making it easier for the baby to hold their head in a neutral position and look in both directions.
When to Seek Professional Guidance
While many mild flat spots improve with consistent repositioning and muscle-releasing techniques, certain signs warrant a consultation with a healthcare professional. If a baby has a strong, persistent head-turning preference or significant neck stiffness that does not improve within a few weeks of at-home efforts, a physical therapy evaluation is appropriate. Physical therapists can provide specific exercises and stretches tailored to the baby’s needs.
Seek a medical opinion if the flatness is severe, if you notice any facial asymmetry, or if the head shape does not show improvement by four to six months of age. A medical professional can also rule out craniosynostosis, a rare condition where the skull plates fuse too early, which requires different treatment than positional flatness. The window for effective repositioning is generally best before six to eight months, as the skull’s growth rate slows down, making early professional guidance valuable.