Plagiocephaly (Flat Head Syndrome)


What is plagiocephaly (flat head)?

Parents and caregivers should always put babies to sleep on their backs to prevent sudden infant death syndrome (SIDS). But when infants spend a lot of time on their backs, they may develop flat head syndrome, or positional plagiocephaly. Repositioning techniques can help reduce the appearance and effects of flat head syndrome.

Symptoms and Causes

What causes flat head syndrome?

Babies’ skulls are soft and somewhat moldable. And infants sleep on their backs for many hours every day. While sleeping, they may consistently turn their head to one side.

If your baby sleeps with a turned head too often, the same section of the head may rest on a surface frequently. The regular pressure can flatten that section of the baby’s soft head.

Flat head syndrome usually happens on one side of the head. But it can occur on both sides or in the back (sometimes called brachycephaly). The longer a part of the head is on a flat surface, the more likely it will flatten.

Are some babies more at risk for plagiocephaly?

Premature babies are more likely to have flattened heads, because their skulls are less developed. They also spend more time lying down while healthcare providers tend to their medical needs.

Some babies may have a muscular torticollis, which is a problem with tight neck muscles. Having torticollis or a premature baby increases the chance of plagiocephaly.

Diagnosis and Tests

How is plagiocephaly diagnosed?

Plagiocephaly is diagnosed visually, when your healthcare provider looks at the baby and observes flattening. No tests can confirm or measure flat head syndrome.

Management and Treatment

How can I reposition my baby to manage flat head syndrome?

The best way to treat plagiocephaly is to vary your baby’s position. You can do this while the baby is asleep or awake.

Over time, repositioning distributes pressure more evenly over the baby’s entire head and strengthens neck muscles. You should:

  • Change your baby’s sleep position often. Alternate the direction your child lies in the crib. Light and activity attract attention, so babies turn toward windows or middles of rooms. If you place the baby’s head at the top of the crib one night and the bottom the next, your baby will look different ways each time.
  • Change your baby’s head position while he or she sleeps. While your baby sleeps, gently move your infant’s head to the side not favored.
  • Hold your baby often to limit your infant’s time spent leaning against a flat surface. Cradle and feed your baby in different positions, switching arms from time to time. Let your baby lie on your chest.
  • Provide lots of supervised “tummy time” while the baby is awake. Tummy time improves flat head syndrome and strengthens your baby’s neck, arms and back.
  • Reduce sleeping time in places where your baby’s head cannot move freely. Avoid too much time in curved baby swings or car seats that restrict movement.
  • Strategically attract baby’s attention. A mobile or other safe toy outside the crib may encourage your baby to turn and look.

What if repositioning isn’t enough?

Most babies with flat head baby syndrome also have torticollis (tight muscles). These infants usually need physical therapy and home exercise programs. A physical therapist will teach you exercises and stretches to lengthen and straighten your baby’s neck muscles.

Your healthcare provider may prescribe a helmet for your baby, which would be measured by an orthotist (a healthcare professional who makes and fits devices such as this helmet). Helmets fit loosely where the head is flat and tightly where it is round. They encourage the flat area of the head to grow.


How do I prevent plagiocephaly?

Infant repositioning is one of the best ways to prevent flat head syndrome.

Outlook / Prognosis

Is flat head syndrome bad for my baby?

Plagiocephaly may change your baby’s appearance. It can lead to less hair on the flattened spot or some facial asymmetry (which may cause visual disturbances). The ear on one side may look pushed forward, or the forehead might bulge. The neck, jaw and face may look uneven.

Are there any risks with repositioning?

Infant repositioning, done correctly, is not risky. But certain sleep techniques are unsafe. Never place your baby:

  • Down to sleep on the belly.
  • Down to sleep on the side.
  • In a crib with soft blankets or toys.

How long do I need to reposition my baby?

A baby’s skull is only soft and moldable for a certain period of time. Repositioning techniques are most effective before four months of age.

Living With

Should I call my doctor if repositioning isn’t helping?

Flat head syndrome can be corrected or minimized with infant repositioning techniques. Starting early and staying consistent helps. If repositioning isn’t working, or if your baby’s neck muscles seem tense, call your healthcare provider. Physical therapy or a helmet may help.

A note from Cleveland Clinic

Repositioning is a useful technique to help babies recover from plagiocephaly, or flat head syndrome. You should never put a baby to sleep on the stomach or side — positions associated with SIDS. Ask your healthcare provider about keeping your baby healthy while sleeping.

Last reviewed by a Cleveland Clinic medical professional on 10/12/2020.


  • American Association of Neurological Surgeons. Positional Plagiocephaly. ( Accessed 9/27/2020.
  • Baby Flat Head. Repositioning Techniques to Help Flat Head Syndrome in Babies. ( Accessed 9/27/2020.
  • Centers for Disease Control and Prevention. Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. ( Accessed 9/27/2020.
  • National Institute of Child Health and Development. Infant Sleeping Position and SIDS. ( Accessed 9/27/2020.

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