Plagiocephaly (flat head in babies) factsheet

Introduction

Plagiocephaly is a condition where the shape of a baby’s head becomes flat or uneven. Plagiocephaly does not impact brain development, but it can affect the appearance of the head, face and ears if left untreated.

Plagiocephaly can develop in the first 6-8 weeks after birth. It can develop when a baby:

sleeps and plays in one position for long periods, usually on their back
always turns their head to one side when lying down.

Constant pressure on one part of the head can cause a flat spot to develop.

Some babies are born with a condition called torticollis, which causes tight neck muscles. This makes it hard for the baby to turn their head fully to one side and increases the risk of developing plagiocephaly.

Signs and symptoms

Most babies will have some differences in the shape of their head from birth. This should settle by six weeks of age.

Signs of plagiocephaly can include:

a very flat spot on one area of the head, usually on one side at the back
one side of the forehead being further forward than the other
one ear being further forward than the other.

Signs of torticollis can include your baby:

tilting their head in one direction
working hard or not being able to fully turn their head towards you
having trouble breastfeeding
preferring to feed from one breast only.

Speak to your local doctor or child and family health nurse if you are concerned or notice signs of torticollis or plagiocephaly.

Diagnosis

Your local doctor can diagnose plagiocephaly or torticollis based on a physical check of your baby.

Depending on how severe it is, they may also:

order some tests and scans to check for other conditions
refer you to a specialist doctor
refer you to an allied health professional, like a physiotherapist.

Treatment

Treatment of plagiocephaly in babies will depend on:

how severe the condition is

what caused it

how old they are.

Mild plagiocephaly can be managed at home with regular checks from your child’s doctor and modifying your baby's sleeping and playing positions.

Physiotherapy

Babies with torticollis may be referred to a physiotherapist who can provide exercises to help ease your baby’s neck tightness and encourage them to move.

Helmet therapy

Helmet therapy may be needed in babies who have more severe plagiocephaly. Helmet therapy involves your baby wearing a lightweight helmet that is fitted by a specialist called an orthotist.

Your baby will start therapy between six and eight months of age, wearing their helmet for 23 hours a day. Therapy will involve regular reviews from your baby’s doctor and should be completed by the time they are 12 months old.

Surgery

Surgery is rare and only used if there is another condition causing issues with the shape of the skull. This includes craniosynostosis, where the gaps in a baby’s skull close too early.

Management

Sleeping

Tips for supporting your baby’s head development during sleep include:

always laying your baby on their back to sleep to lower the risk of Sudden Infant Death Syndrome (SIDS)
changing the direction your baby's head faces each night when putting them down to sleep to help spread pressure more evenly across the skull. For example, turning their head to the left one night and the right the next night
changing the position of your baby’s bassinet or switching the end where you place your baby's head to encourage them to look in different directions when they wake up.

Playtime

One of the best ways to prevent or manage plagiocephaly is supervised tummy time play while your baby is awake.

When your baby lies on their tummy, it helps relieve pressure on the back of their head and strengthens the muscles needed for reaching movement milestones like:

rolling
sitting
crawling.

Tummy time can be challenging for babies, and they may cry. Start with a few minutes a few times a day and gradually increase as your baby gets stronger.

You can also encourage your baby to play on their side while awake by placing different toys or pictures on each side or talking to your baby from different directions.

Holding your baby

Try to change how you carry your baby throughout the day so they don’t stay in one position too long. Always support your baby’s head and neck, and try:

using a carrier
holding them upright, facing outwards
alternating which shoulder you hold them on
carrying them over your arm on their tummy or side.

Baby containers

Try to limit the use of baby containers such as:

car seat capsules
bouncers
swings
rockers.

While these containers can provide a safe space for your baby while you manage tasks, other children, and pets, using them for too long can have negative effects like:

putting too much pressure on your baby's head
restricting their movement
reducing the amount of tummy time they get during the day.

Consider using a playpen to keep your baby safe from siblings and pets while on the floor, or actively limit the amount of time they spend in a baby container throughout the day.