The facts on flat head syndrome

According to the American Academy of Pediatrics, an estimated 46% of newborns are either born with a flat spot (known as flat head syndrome or positional plagiocephaly) on their head or develop one during the early weeks of life. Fortunately, many cases of flat head syndrome can be easily treated or prevented, especially when caught early.

What causes flat spots?

Flat spots are sometimes due to pressure on a baby’s soft skull in the womb or during birth. They can also be caused or worsened by too much time spent in one position during sleep, feedings, or daily routines. Premature babies are especially susceptible to flat spots as their skulls are softer than those of full-term babies. 

Tips for avoiding a flat spot

Even if your baby isn’t yet showing signs of a flat spot, pediatric occupational therapist Rachel Coley suggests these tips:  

Do lots of tummy time. If your baby rests cheek-down in tummy time, be sure to give equal time with their head turned in each direction. With one of your palms on each side of their head, slowly and gently lift and turn their head so your baby can rest on the other cheek.

Limit time in baby gear. Baby gear is a category that includes car seat carriers (any time you aren’t driving), infant loungers, bouncy seats, strollers, and infant swings.

Carry or wear your baby. Spending time in an upright position decreases the pressure on the back and sides of your baby’s head.

Vary their head position. Change your baby’s position as you lay them in their crib and hold, carry, and feed them, especially if bottle feeding. If your newborn tends to sleep with their head turned to one side, you can gently turn their head in the opposite direction while they’re asleep.

Signs of a developing flat spot

Because flat spots form gradually, they can be hard to detect. Every week or so, take a look at the following areas to help identify any changes in head shape:  

Look down at the top of your baby’s head. Signs of a developing flat spot might include one ear shifted forward more than the other, a head almost as wide as it is long, or sloping of the forehead or back of the head toward one side.

Look at your baby from below their chin while they’re lying on their back. Signs of a developing flat spot may include asymmetry of the jaw, lips, cheekbones, or eyebrows.

Look at your baby’s face straight on. Signs of a developing flat spot may include eyes that are different sizes or aren’t even, one cheek fuller than the other, bulging above the ears that sometimes pushes the tips of the ears out, head tilt toward one shoulder or turn in one direction.

Look at each side of your baby’s head in profile. Signs of a developing flat spot include a “tall” head shape that is higher in the back and slopes toward the forehead; head looking flatter in the back of one profile than the other side’s profile.

Treatments for flat head syndrome

Early detection and treatment go a long way toward correcting a flat spot. If you notice an irregularity, your baby’s pediatrician can provide a diagnosis and recommend treatment options. Depending on your baby’s age and the severity of head flattening, treatments may include diligent repositioning of their head throughout the day, physical therapy or bodywork to treat tight neck muscles and, in some cases, helmet therapy.

Learn more about the research

Mawji, A., Vollman, A. R., Hatfield, J., McNeil, D. A., & Sauvé, R. (2013). The incidence of positional plagiocephaly: a cohort study. Pediatrics, 132(2), 298-304.