The soft, pliable skull bones of an infant are vulnerable to constant external pressure, which can lead to Positional Plagiocephaly, commonly called “flat head syndrome.” This condition is defined by a flattening on one side or the back of the head, occurring because the skull is molded by prolonged contact with flat surfaces. Positional Plagiocephaly has become increasingly common since the recommendation to place babies on their backs for sleep. This change in head shape is highly preventable through simple, consistent positional changes that relieve pressure on the scalp. Prevention strategies focus on giving the back of the head a break during waking hours and encouraging the baby to turn their head frequently.
The Power of Tummy Time
The most active and effective strategy for preventing a flat spot is incorporating supervised Tummy Time throughout the day. Tummy Time strengthens the neck, shoulder, and upper body muscles, allowing the baby to gain the control needed to lift and turn their head away from a flat surface. This activity should begin as early as the first day home from the hospital, once the umbilical cord stump has healed.
Initial sessions should be short, aiming for three to five minutes, two to three times per day, ideally after a diaper change or a nap. Gradually increase the frequency and duration, working toward a total of 60 to 90 minutes of Tummy Time throughout the day by three to four months of age.
If a baby resists being placed directly on a floor mat, several variations can help. Try placing the baby belly-down on a parent’s chest while the parent is reclined; this is a comforting start for newborns. Another option is placing a small, rolled towel under the baby’s chest and armpits, which slightly props them up and makes lifting the head easier. Making Tummy Time engaging by using toys, mirrors, or lying down at the baby’s level can extend the duration of each session. Consistent practice builds the muscle strength necessary to keep pressure distributed evenly.
Changing Head Position While Lying Down
While Tummy Time is an active solution for waking hours, passive repositioning is necessary when the baby is lying on their back for sleep. The fundamental rule is to ensure the baby is not resting their head in the same spot for every nap and sleep period. Repositioning focuses solely on the head, as the torso must remain supine to adhere to safe sleep guidelines.
A simple technique is to alternate the direction the baby faces within the crib each night. Place the baby’s head toward the head of the crib one night, and toward the foot the next. Since infants naturally prefer to look out into the room or toward a light source, this alternation encourages them to turn their head toward different stimuli.
Parents can also utilize visual and auditory cues to encourage the head to turn off the flattened side. Place a mobile, a window, or the parent’s face on the side that requires more pressure relief, prompting rotation. During feeding, alternate the arm used to hold the baby, which changes the angle of the baby’s head and the direction they look at the caregiver. This consistent encouragement helps strengthen the neck muscles symmetrically.
Reducing Use of Restrictive Equipment
Excessive use of equipment that keeps an infant in a fixed position is a contributor to positional flattening. Items like car seats, swings, bouncers, and rockers place constant pressure on the back of the head. While these devices are designed for convenience or safety, they significantly limit a baby’s ability to move their head freely.
Limit the total time spent in these restrictive devices. A car seat should be used only for travel and not as a substitute for a crib or play area. Prioritize holding the baby or placing them on a flat, firm surface for supervised “free play” time outside of Tummy Time. This allows the head to move naturally and prevents the prolonged pressure that causes flattening.
When to Consult a Pediatrician
While preventative measures are effective, parents should monitor their baby’s head shape and neck movement and know when to seek professional guidance. Signs that warrant an evaluation include severe flattening that does not improve with repositioning techniques. Parents should also look for facial asymmetry, such as one ear appearing pushed forward compared to the other, or a bulging forehead on the side corresponding to the flattened area.
A physician consultation is important if the baby consistently struggles to turn their head equally to both sides. This may indicate Torticollis—a condition involving tight neck muscles. Torticollis often co-occurs with Positional Plagiocephaly and requires specific physical therapy exercises to regain full range of motion. If repositioning proves insufficient, the pediatrician can confirm the diagnosis and discuss advanced treatment options, such as physical therapy or cranial orthosis (helmet therapy) in moderate to severe cases.