A flat spot on your baby’s head is remarkably common, and knowing what to watch, what to change at home and when to have it checked can make the next step much clearer.
In this article
- What is plagiocephaly, and how common is it?
- Why do flat spots happen in the first place?
- How to check your baby’s head shape at home
- When is a flat spot worth having checked?
- What you can do at home, starting today
- How can pediatric care help with a flat head?
- What about helmets?
- Frequently asked questions
- Where to start
A lot of babies develop a flat spot on the back of their head in the first few months, and a lot of parents discover it in the least relaxing way possible: during a feed in the middle of the night, followed by several hours of comparing photographs and reading everything they can find online in the wee hours of the morning. You may have been told that it’s nothing to worry about and that it’ll round out once your baby is sitting, and for many babies that is exactly what happens. However, some flat spots don’t change very much on their own, particularly when a baby strongly prefers looking in one direction, and those early months are also when the head is growing most quickly. This guide will help you look at your baby’s head shape without turning it into another thing to monitor constantly, make a few useful changes at home and recognize when it would be helpful to have someone take a proper look.
What is plagiocephaly, and how common is it?
Plagiocephaly is the medical term for a flattened area on a baby’s head. The common type, called positional plagiocephaly or flat head syndrome, develops when repeated pressure on one area gradually changes the shape of a skull that is still soft and growing quickly. It usually appears on one side at the back of the head. When the flattening runs more evenly across the whole back, it is called brachycephaly. It’s also far more common than most parents realise. When researchers in Calgary checked 440 healthy full-term babies at their two-month well-baby visits, 46.6 per cent had some degree of flattening, and most of those cases were mild. What a flat spot may tell us is that something else, such as a tight neck or strong head preference, is affecting how your baby moves and rests, and that is worth paying attention to. There’s also a much rarer condition called craniosynostosis, which affects roughly one baby in 2,000 and happens when one or more of the seams between the skull bones close earlier than they should. It needs a medical assessment, so we’ll explain the signs that should take you to your family doctor or paediatrician rather than asking you to decide between the two conditions at home.
Why do flat spots happen in the first place?
The biggest reason is also a very good one. Babies should be placed on their backs for every sleep, and that same safe-sleep advice has saved a great many lives. A young baby also spends many hours with the back of the head resting against a firm surface, and because the skull is still soft and growing quickly, repeated pressure in the same place can gradually change its shape. Head preference is the other big piece. Many babies find one direction more comfortable, whether that is related to their position in the womb, tension through the neck or simply where the window, your face and the rest of the action tend to be. In the Calgary research, a strong preference for one side was among the factors most closely associated with a flat spot, along with back sleeping, vacuum or forceps delivery and being a boy. If your baby almost always looks the same way, our article on head preference and torticollis explains why that happens and what else to watch for. Long stretches in car seats, swings, bouncers and loungers can add more time on the back of the head, while twins, a snug position in the womb and being born early can also be part of the picture. These are risk factors, not a list of things a parent has done wrong. Most of them are simply part of how pregnancy and early babyhood unfolded.
How to check your baby’s head shape at home
The easiest way to look at head shape is from above. After a bath, while your baby’s hair is damp and lying flat, look straight down and notice whether the back of the head appears evenly rounded or flatter on one side. Taking a photograph from the same angle every couple of weeks can be useful, because gradual changes are much easier to see side by side than they are from memory. You definitely don’t need to photograph it every day. While you are looking, notice whether one ear sits a little farther forward, whether the forehead or one cheek looks fuller on the same side as the flat spot, or whether the head looks especially wide and short from behind. Then pay attention to movement. A baby who turns easily in one direction but stops short in the other, keeps the head tilted toward one shoulder or finds feeding on one side considerably harder may also be showing you that the neck is involved.
When is a flat spot worth having checked?
A mild flat spot in a baby who turns freely in both directions often improves as time spent off the back of the head increases. It’s worth having it checked if you’ve been making those changes for a few weeks and the shape isn’t improving, if your baby clearly prefers one side or tilts the head, if an ear or the forehead seems to be shifting forward, or if tummy time has become a daily battle that nobody is winning. A baby’s head grows fastest in the first few months, which is exactly why it can flatten and why simple changes tend to have the most effect when they begin early. This doesn’t mean that you’ve missed your chance if your baby is already several months old. It does mean that there’s no particular benefit to waiting until the flat spot is more noticeable before asking someone to look at it. Please see your family doctor or paediatrician promptly if your baby’s head appeared unusually shaped from birth and the difference is becoming more pronounced despite position changes, if you can feel a hard ridge along the skull, if the soft spot seems to have closed very early or if the shape doesn’t look like a typical flattened area at the back. Craniosynostosis is uncommon, but it needs a medical assessment and should be ruled out before the focus shifts to positioning or therapy. Not sure where to start? A free 20-minute Care Navigator call gives you a chance to explain what you are noticing before you choose between paediatric physiotherapy, osteopathy or chiropractic care. We’ll help you decide which appointment makes the most sense, or let you know when your family doctor should be the first call. Book through our Toronto clinic or our Newmarket clinic.
What you can do at home, starting today
Keep placing your baby on their back for every sleep, on a firm, flat surface with nothing else in the sleep space. Positioning pillows, wedges and head-shaping pillows can look like an easy solution, but they aren’t safe for sleeping and don’t belong in a crib. The changes used for a flat spot should happen while your baby is awake and supervised, because safe sleep advice doesn’t change when plagiocephaly is part of the conversation. What you can change is the direction your baby is encouraged to look. Babies usually turn toward the room rather than the wall, so alternating which end of the crib their head is placed at can encourage them to look the other way without adding another exercise to your day. The same idea works during awake time when toys, a mirror or your face are placed on the side they use less often. Tummy time is the other important piece. The Canadian Paediatric Society recommends supervised tummy time while your baby is awake for 10 to 15 minutes at least three times a day, but a young baby doesn’t have to do all of that on the floor. Time on your chest while you recline counts, as does a minute or two across your lap after a diaper change. Plenty of babies who object loudly to a play mat are perfectly content to be on their stomach on a parent, and several short attempts through the day are usually far more manageable than one long session that ends with everyone upset. You can also switch the arm you use for carrying and, if you’re bottle-feeding, alternate feeding sides. Use the car seat for travel rather than as a place for naps around the house, and carry your baby upright in your arms or a carrier when it works for both of you. The goal is simply to create more supervised time off the flattened area without turning the entire day into a head-positioning project.
How can pediatric care help with a flat head?
When the shape isn’t changing with home strategies, or when your baby clearly prefers one direction, paediatric care can help you understand what is keeping the pattern going. The Congress of Neurological Surgeons guideline on positional plagiocephaly recommends physiotherapy over repositioning education alone for babies seven weeks and older, with high confidence in that recommendation. A commentary in the Canadian Paediatric Society’s journal also encourages early checks of head shape and neck movement, since a flat spot may be one of the first clues that movement and development deserve a closer look. A paediatric physiotherapist will look at your baby’s head shape, check how freely the neck turns and tilts, and watch how your baby is moving for their age. From there, the plan may include gentle stretches, ways to change the positions you are already using and a tummy-time approach that is realistic around feeds and naps. In Toronto, you can book a pediatric physiotherapy assessment for babies and toddlers up to three years old. In Newmarket, Carmen Ene sees babies from birth to six months and babies six months and older. Other Oona services may fit alongside physiotherapy when neck comfort, movement or everyday positioning is part of the concern. Pediatric osteopathy, available at our Toronto clinic, uses very light hands-on techniques, and you can read more about what an appointment looks like in our guide to pediatric osteopathy. Our paediatric chiropractors in Toronto and Newmarket use gentle, low-force approaches when neck movement and comfort are part of the picture. Our pediatric occupational therapists in Toronto and Newmarket can help with positioning and handling strategies during feeding, play and other daily routines. None of these services replaces a medical assessment when craniosynostosis or another medical concern needs to be ruled out, and your baby definitely doesn’t need to see every type of practitioner. The point of the first conversation is to work out where it makes sense to begin.
What about helmets?
A cranial moulding helmet is a lightweight, custom-fitted helmet worn for most of the day over several months. It gives the flatter area room to grow while gently limiting growth where the head is already more rounded. A helmet assessment may be discussed when flattening remains moderate to severe after repositioning or physiotherapy, often around four to six months while the head is still growing quickly. The evidence is more mixed than helmet marketing sometimes makes it sound. The neurosurgical guideline found a substantial body of non-randomised studies showing faster and greater improvement with a helmet, particularly when more severe flattening was treated at the right stage of infancy. However, the randomised trial did not reach the same conclusion. The guideline supports beginning with repositioning and physiotherapy for younger babies with milder flattening, while considering a helmet for persistent moderate-to-severe cases. We don’t fit helmets at Oona, but a paediatric physiotherapist can help you understand whether a helmet assessment is worth discussing with your doctor and can continue supporting neck movement and development if your baby wears one.
Frequently asked questions
Will my baby’s flat head go away on its own?
Mild flattening often improves as a baby spends more time upright, rolling and sitting. More noticeable flattening may not fully resolve on its own, especially when a head preference keeps pressure on the same area. Start with simple changes early and have the shape checked if you aren’t seeing improvement after a few weeks.
Does plagiocephaly affect my baby’s brain?
Positional plagiocephaly doesn’t restrict brain growth in the way craniosynostosis can. Research has found associations with developmental differences, but it hasn’t shown that the flat head shape causes them. A flat spot may also point to a neck preference or movement pattern that is worth having assessed.
Can my baby sleep on their side or tummy to take pressure off the flat spot?
Your baby should always be placed on their back for sleep, on a firm, flat surface with no pillows, wedges or positioners. You can take pressure off the flat spot during awake time with tummy time, holding and upright carrying instead.
Is it too late to help my baby’s flat head?
There isn’t a single age after which nothing can help, although the head grows fastest in the first months of life and early changes usually have the greatest effect. If your baby is already several months old, it’s still worth having the shape assessed because there may be plenty of growth left to work with.
Is a flat head connected to torticollis?
The two are often connected, because a tight neck muscle can make it hard for a baby to turn both ways, so they rest on the same spot again and again. If your baby favours one side, our article on head preference and torticollis covers what to look for.
How can I tell plagiocephaly from craniosynostosis?
Positional plagiocephaly usually looks like a flattened patch at the back of the head, often with the ear on that side sitting slightly forward, and it tends to improve as position changes. Craniosynostosis is much rarer, may involve a hard ridge along the skull or a shape that was unusual from birth and keeps getting more pronounced, and needs to be assessed by a doctor.
Do I need a referral to book pediatric physiotherapy at Oona?
You don’t need a referral to book any service at Oona, so you can book paediatric physiotherapy in Toronto directly, or in Newmarket for babies under six months or six months and older. If you have concerns about craniosynostosis, please see your family doctor or paediatrician first.
Where to start
Most flat spots are mild, and the small changes that fit into your day, including varying the direction your baby looks, building up supervised tummy time and creating more awake time off the back of the head, are usually more useful than any special product. If the shape isn’t improving, your baby strongly favours one side or you would simply feel better having someone look, an early assessment gives you clearer information while there is still plenty of growth to work with. You can book paediatric physiotherapy in Toronto, or in Newmarket for babies under six months or six months and older. If you would rather talk it through first, book a free Care Navigator call through Toronto or Newmarket. No referral is needed, and we are accepting new patients. Sources: Mawji et al., Pediatrics (2013); Canadian Paediatric Society, Caring for Kids: Preventing flat heads in babies who sleep on their backs; Congress of Neurological Surgeons, positional plagiocephaly guideline: repositioning; Congress of Neurological Surgeons, positional plagiocephaly guideline: helmet therapy; Time to revisit tummy time, Paediatrics & Child Health
