When a parent notices flattening on their infant’s head, they often question the necessity of intervention. This concern about developing asymmetry leads many to wonder about the outcome if they choose not to pursue treatments like a cranial orthotic device. The ultimate shape of the child’s head depends heavily on the specific type of flattening, the child’s age, and the severity of the deformation. Understanding the natural course of head growth and alternative management strategies is important for parents navigating this common developmental stage.
Understanding Positional Head Flattening
The most frequent causes of an altered head shape are Positional Plagiocephaly and Positional Brachycephaly, classified as deformational conditions. Positional Plagiocephaly is asymmetrical flattening on one side of the back of the head, often causing the ear on that side to shift forward. Positional Brachycephaly is a symmetrical, broad flattening across the entire back of the skull, resulting in a wider head shape and sometimes a prominent forehead.
Both positional conditions result from sustained external pressure on the soft, rapidly growing skull bones. This typically occurs when an infant spends too much time in the same position on their back. The skull sutures remain open and flexible, meaning the brain’s growth is not restricted.
This distinguishes these benign conditions from Craniosynostosis, a rare disorder where one or more skull sutures fuse prematurely. Craniosynostosis prevents the skull from expanding normally, potentially restricting brain growth, and almost always requires surgical intervention. Positional head flattening does not involve fused sutures and is primarily a cosmetic concern.
The Critical Timing for Self-Correction
If a parent chooses not to pursue a helmet, the outcome relies on the infant’s natural head growth and motor development for correction. The skull is most malleable and its growth is most rapid during the first six months of life, creating a window for passive correction. As the brain expands, it pushes the skull outward, and removing constant pressure allows the flattened area to round out.
Spontaneous correction depends highly on the initial severity of the flattening. Mild cases often resolve completely without formal intervention as the baby gains better head control and moves their head independently. Once an infant can sit up without support and spends less time on their back, the forces causing the flattening are naturally relieved, leading to improvement.
The effectiveness of natural correction and helmet therapy decreases significantly after the first year, as skull growth slows dramatically. Approximately 85% of cranial growth occurs in the first 12 months, after which the skull bones harden and sutures become less flexible. By 12 to 18 months of age, the skull is resistant to reshaping, meaning any remaining flattening is likely permanent. For moderate to severe cases not improving by six months, achieving a fully rounded head shape without a molding helmet drops considerably.
Active Management Through Repositioning and Physical Therapy
For parents who opt against a cranial orthotic device, active, non-helmet management is the first line of defense, especially in the first few months of life. This management involves “counter-positioning,” which means carefully adjusting the baby’s position to reduce pressure on the flattened area. This technique must be practiced consistently throughout the day and night while the baby is awake and supervised.
Tummy Time and Counter-Positioning
Tummy Time is a key strategy, encouraging the baby to lift their head against gravity and strengthening neck and shoulder muscles. Increasing the duration and frequency of Tummy Time sessions removes pressure from the back of the head and promotes symmetrical development. Other counter-positioning methods include changing the direction the baby’s crib faces so they must turn their head to look at a point of interest, like a window or door.
Addressing Torticollis
Positional flattening is often linked to Torticollis, a condition where tight neck muscles cause the baby to consistently favor turning their head to one side. If a baby cannot easily move their head away from the flat spot, repositioning alone will be ineffective. A referral to a physical therapist is necessary to teach parents specific stretching and strengthening exercises that improve neck mobility and allow the infant to distribute pressure across their head.
Persistent Deformity and Long-Term Implications
If positional head flattening remains moderate to severe after the window of rapid head growth has closed, the primary long-term consequences are cosmetic and functional. Persistent Plagiocephaly outcomes include noticeable facial asymmetry, such as a prominent forehead on one side, and ear misalignment, where one ear is positioned further forward than the other. In Brachycephaly, the head may retain a proportionally wide shape with a steep vertical back.
Although significant neurodevelopmental delays are not directly caused by positional flattening, the asymmetrical head shape can lead to practical challenges later in life. The misalignment can make it difficult to properly fit common items like glasses, goggles, or protective headgear for sports. Furthermore, severe, uncorrected asymmetry can have a psychological impact, including issues with self-esteem and social interactions. These persistent cosmetic and practical issues are the main factors parents must weigh when deciding whether to pursue active treatment during infancy.