What Should I Do If My Baby's Head Is Flat?

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Have you ever seen a baby rocking a cute little helmet and wondered what it’s for? The distinctive headgear may be part of a treatment plan for plagiocephaly — also known in plain-speak as flat head baby or flat head syndrome.

You’ve probably heard that babies delivered vaginally may come out with heads that look a little pointy due to pressure from the birth canal. What you may be less familiar with, though, is the medical condition that results in the appearance of a misshapen head beyond childbirth, its causes, and subsequent treatment options. Here’s what you should know about flat head syndrome.

What is a flat head baby?

Flat head syndrome, or plagiocephaly, occurs when a baby’s head develops a flat spot. There are actually two types of plagiocephaly: positional and congenital. The most common type is positional, which is also known as deformational. It affects up to 50 percent of babies, according to the American Academy of Family Physicians.

The other type is congenital plagiocephaly, or craniosynostosis, which is a rare birth defect. With this type of plagiocephaly, the fibrous spaces between a baby’s skull bones prematurely close. This results in an abnormally shaped head.

For the sake of this article, we’ll largely stick to discussing positional plagiocephaly, or flat head syndrome.

What causes flat head syndrome?

Since the American Academy of Pediatrics began recommending that infants sleep on their backs to reduce the chance of SIDS, positional plagiocephaly has been on the rise. If you’re a silver-lining kind of person, you can look at this as a sign that parents are doing their best to keep their babies safe. Because, as you might have guessed by the name, positional plagiocephaly is linked to a baby spending a lot of time in one position: on their back. This might be in a rocker, a car seat, a baby swing, a playpen, a baby mat on the floor — you get the picture.

Premature babies and multiples are more likely to experience flat head syndrome. With premature babies, this can be traced to the fact that their skulls are softer since they didn’t get as much time to harden as full-term babies. Plus, premature babies often have medical needs that require them to be on their backs for extended periods of time. For example, they may need to stay in an incubator in the neonatal intensive care unit (NICU).

With multiples, it’s simply a matter of space. Being cramped in the womb can cause torticollis. Latin for “twisted neck,” this condition is marked by tight muscles on the side of the neck that make it difficult for baby to turn their head. Hence, developing a flat spot from keeping their head in the same position when lying down.

When is flat head syndrome apparent?

Parents usually notice positional plagiocephaly around six to eight weeks old. However, it’s possible your child’s pediatrician will bring it up even earlier. Examining baby’s head (physically, visually, or both) is often a routine part of well-baby visits. If you notice any irregularities in your baby’s head, it’s always best to bring them up to the doctor. Positional plagiocephaly is easier to resolve the earlier it is recognized.

In addition to obvious flat spots, signs of positional plagiocephaly may include flattening on one side of the back of the head, head tilted to one side, uneven cheekbones, ears pushed forward on the side of the head with flattening, or a bald spot in the area of the flattening.

When should you worry about a flat head?

Fortunately, most babies with positional plagiocephaly don’t suffer adverse health effects. According to Children’s National Hospital, though, congenital plagiocephaly may lead to serious complications if left untreated. So, if you notice any possible signs of flat head syndrome, bring it up with your pediatrician. They’ll want to rule out the latter or, if diagnosed, develop an immediate treatment plan.

How do you fix it?

If your baby’s doc does determine they have positional plagiocephaly, the treatment will depend on the severity of the condition. The most common treatment is “positioning therapy,” or reducing pressure on the skull by making sure baby doesn’t spend too much time in one position. This typically involves lots of tummy time (ideally at least 30 minutes per day). Of course, you should never leave your little one unsupervised during tummy time for safety’s sake.

Another way to help keep your baby’s head round is to switch up the sides you lay down your baby. Don’t always put them down to sleep on their right side. Mix it up and make a note of which side your baby took a nap on, so you can make sure you’re rotating sides. And, don’t be afraid to sneak into your baby’s room while they’re sleeping to turn their heads from left to right, every hour or so.

It also helps to hold your baby in your arms more. You want to lessen the amount of time your little one rests on their back and head. When they’re in your arms, your baby’s head isn’t pressed against a flat surface, which limits the pressure on their forming heads. It’s also a great way to increase skin to skin contact with your little one, which is always a bonus.

Let’s say you’ve been working hard to make adjustments, and your baby’s head shape doesn’t seem to be changing. In that case, their pediatrician may recommend a special helmet to help gently reshape the head. In rare (and very severe, most often congenital) cases, your doctor may even want to discuss surgery as a corrective option.

Are baby flat head pillows safe?

One growing trend in response to flat head syndrome is the use of baby head shaping pillows. But the surge in popularity of these products begs the question, “Are they safe?” As you may have guessed, many medical professionals aren’t fans. Per the FDA, you should “never use infant sleep positioners” and, similarly, never put “pillows, blankets, loose sheets, comforters, or quilts under a baby or in a crib.” Doing so may put your child at increased risk for suffocation of SIDS.

Why is it bad for a baby to have a flat head?

Obviously, we get why you don’t want your baby to have a flat head. However, aside from aesthetic reasons, a flat head can be pretty harmless. However, when ignored it can pose serious health risks if left unchecked. It can lead to issues with your baby’s neck muscles. If those bones set in a certain way, it can become incredibly difficult for your baby to lift their head. However, no matter how serious your baby’s head flattening becomes it won’t impact your child’s brain development.

Is it normal for a baby’s head to be uneven?

We love our babies, but when they come out they don’t always come out…even. But don’t worry mama! That is both OK and very common during the first few weeks of life. So if your baby’s head is a bit lopsided, it’s only because their skull isn’t fully fused and developed.