Plagiocephaly (Flat Head Syndrome)

What is positional plagiocephaly?

Positional plagiocephaly (pronounced “play-jee-oh-seh-fuh-lee”), or flat head syndrome, is a condition in which your infant’s head develops a flat spot or is misshapen. It usually affects one side of your baby’s head. This can make your baby’s head look abnormal or asymmetrical.

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. Repositioning techniques can help reduce the appearance and effects of flat head syndrome.

Types of plagiocephaly

Positional plagiocephaly, sometimes called deformational plagiocephaly, is the most common type of plagiocephaly. There are other types, including:

• Brachycephaly: This type causes a flattened appearance on the back of your baby’s head. The back of their head may appear shorter and wider.
• Scaphocephaly: This type of plagiocephaly causes your baby’s head to have a long, narrow shape. This type is common in premature babies who spend time in the neonatal intensive care unit (NICU).
• Craniosynostosis: Also called congenital plagiocephaly, this type is a rare, serious birth defect. When the fibrous joints between the bones of your baby’s skull (cranial sutures) prematurely close, it causes a deformity.

How common is positional plagiocephaly?

According to studies, positional plagiocephaly occurs in up to 50% of babies and it’s usually very mild.

What are the symptoms of plagiocephaly?

Plagiocephaly symptoms vary based on type and level of severity. Positional plagiocephaly symptoms may include:

• Flattened area on the front, side or back of your baby’s head.
• Missing hair in one spot on your baby’s head.
• Misshaped or slanted head.
• Forehead, eye or cheek that appears larger or fuller on one side.
• Nose that appears pushed to one side.
• Uneven ears (one ear pushed up or forward on your baby’s head).

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 their head may rest on a surface frequently. Regular pressure can flatten that section of your baby’s soft head.

Are some babies more at risk for positional plagiocephaly?

Premature babies are more likely to have flattened heads because their skulls are less developed. They also spend more time lying down in the hospital and at home.

Some babies with plagiocephaly also have a condition called congenital muscular torticollis. It occurs when tightening in your infant’s neck muscles causes their head to twist and rotate to one side. Torticollis can be treated with physical therapy.

Other factors that increase your baby’s risk for plagiocephaly include:

• Pregnancy with multiples.
• Assisted delivery with forceps or vacuum extractor.
• First-born child.
• Assigned male at birth.
• Low level of activity.
• Lack of tummy time.

How is positional plagiocephaly diagnosed?

You may notice the flattening of your baby’s head by 6 to 8 weeks of age. Your baby’s healthcare provider can diagnose plagiocephaly visually by looking at your baby and observing the flattening of their head. Your child’s provider doesn’t need any tests to confirm or measure flat head syndrome.

How is positional plagiocephaly treated?

Plagiocephaly treatment starts with changing your baby’s position. You can do this while your baby is asleep or awake.

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

• Change your baby’s sleep position often: Light and activity attract attention, so babies turn toward windows or the middle of rooms. If you place your 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 they sleep: While your baby sleeps, gently move their head to the side they don’t usually favor.
• Hold your baby often: This limits the time your infant spends 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 your 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 can’t move freely: Avoid too much time in curved baby swings or car seats that restrict movement.
• Strategically attract your baby’s attention: A mobile or other safe toy outside their crib may encourage your baby to turn and look.

Are there any risks with repositioning?

Infant repositioning, done correctly, isn’t risky. But certain sleep techniques are unsafe. Never place your baby:

• Down to sleep on their belly.
• Down to sleep on their 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 4 months of age.

What if repositioning isn’t enough?

Some babies with flat head syndrome also have torticollis (tightened neck 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.

If the plagiocephaly is bad, your healthcare provider may prescribe a plagiocephaly helmet for your baby. An orthotist (a healthcare provider who makes and fits medical devices) will measure the helmet for your baby’s head. Helmets fit loosely where the head is flat and tightly where it’s round. They encourage the flat area of the head to grow. Your baby will wear the helmet for several months to reshape their skull.

How do you prevent flat head syndrome?

Infant repositioning is one of the best ways to prevent flat head syndrome. Be sure to alternate your baby’s head position while they’re sleeping. In addition, give your baby plenty of tummy time while they’re awake and you’re supervising them.

What can I expect if my baby has positional plagiocephaly?

Most infants with plagiocephaly grow out of the condition naturally. Others need to correct it with treatment. Talk to your baby’s healthcare provider about your child’s case.

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

You should be able to correct or minimize flat head syndrome 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 their healthcare provider. Physical therapy or a helmet may help.

What questions should I ask my baby’s healthcare provider?

Questions you may want to ask your child’s provider include:

• Could my infant’s head correct itself without treatment?
• Are there long-term effects of not treating flat head syndrome?
• How might my baby react to wearing a plagiocephaly helmet?
• Will insurance cover the cost of a plagiocephaly helmet?
• Can positional plagiocephaly return after treatment?

Is flat head syndrome bad for my baby?

Flat head syndrome doesn’t cause any brain damage or affect your baby’s health. However, it 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 of your baby’s head may look pushed forward or their forehead might bulge. Their neck, jaw and face may look uneven.

Is flat head syndrome a sign of neglect?

No. Positional plagiocephaly isn’t the parents' or caregivers’ fault. In fact, the condition often occurs because of something you were doing right — placing your baby to sleep on their back.

A note from Cleveland Clinic

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