How To Prevent Flat Head Syndrome

A few simple repositioning habits can help protect your baby’s head shape

For many new parents, “tummy time” can feel like just another buzzword added to your baby’s already long to-do checklist. But those few minutes a day help strengthen the neck and arm muscles your baby needs to eventually sit up, crawl and walk.

Tummy time also has another important role: preventing flat head syndrome, or positional plagiocephaly.

“Babies can develop a flat spot on the side or across the back of their heads from spending lots of time in one position,” says Cameron Brimley, MD, a pediatric neurosurgeon at Geisinger. “And while babies sleep safest on their backs to reduce the risk of SIDS (sudden infant death syndrome), there are steps parents can take to protect the shape of their baby’s delicate skull during the day.”

For most babies, a few simple repositioning habits is all it takes to help reduce the appearance and effects of flat head syndrome.

What is flat head syndrome?

Babies spend most of the day — and night, if you’re lucky — lying down. But because their skull bones are still soft and flexible, steady pressure from spending too much time in one position can create a flat spot or mild asymmetry on baby’s head over time. This is called flat head syndrome (positional plagiocephaly).

“A baby’s skull is designed to be soft and flexible during the first year of life, so the brain has room to grow,” says Dr. Brimley. “The bones don’t start to fuse together until around 12 to 18 months, which is why head shape can change fairly easily during infancy.”

Flat head syndrome is usually caused by extended time in car seats, swings or bouncers. It also can happen if babies have tight neck muscles — called torticollis — which can make it harder for them to comfortably turn their head both ways. Premature babies and multiples (less room in the womb) are at higher risk.

Thankfully, positional flat spots do not affect brain growth or development. Mild flattening often improves naturally as babies grow and become more mobile. But more noticeable cases can benefit from treatment.

Signs of flat head syndrome

Flat head syndrome is common, but it’s often preventable — and easily treatable when caught in babies’ first few months of life.

“Flattening is most common between 2 and 4 months, when babies lie on their backs much of the day and their head and neck control is still developing,” says Dr. Brimley.

Changes in head shape usually happen gradually. Watch for:

A flat area on one side or across the back of the head
An uneven or asymmetrical head shape when viewed from above
Hair loss or thinning in one spot on your baby’s head
Uneven ears, or 1 ear appearing slightly farther forward than the other
A forehead that seems more prominent on one side

If you notice any signs of positional flat head syndrome, talk to your pediatrician. Early intervention is important while your baby’s skull is still moldable.

Tips on how to prevent flat head syndrome

It often only takes a few small changes for prevention and correction of flat head syndrome. Try incorporating these tips into your baby’s daily routine:

Alternate head positions during sleep

Since babies spend so much time sleeping on their backs, changing their head position frequently reduces pressure on one area of the skull.

Try gently turning your baby’s head to one side for a nap or nighttime sleep, then switch sides the next time. You can also switch which end of the crib you place your baby for sleep, so they naturally look toward room activity from different directions.

“But safe sleep comes first,” says Lauren Scheeler, PA-C, a physician assistant in pediatric neurosurgery and Geisinger’s Head-Shape Multidisciplinary Clinic. “For every sleep, always place your baby on their back on a firm mattress with a fitted sheet and no soft bedding or pillows. Nothing else should be in the crib with your baby.”

Avoid sleep positioners, wedges or pillows designed to keep your baby’s head in place. They aren’t safe.

Incorporate tummy time

Building tummy time into your daily routine is one of the best ways to help prevent flat spots, while also supporting healthy motor development.

“Tummy time gives your baby’s head a break from pressure on the back of the skull,” says Ms. Scheeler. “It also helps strengthen their neck, shoulder and arm muscles they’ll need for rolling, sitting and later crawling.”

Aim for 10 to 15 minutes, 2 to 3 times a day at first. Gradually work toward 30 minutes or more spread throughout the day by around 3 months of age. Just be sure you’re always supervising tummy time to keep your child safe.

If your baby doesn’t like tummy time, don’t be tempted to skip it. Instead, try shorter sessions and interact with your baby by getting down at eye level, talking and singing to them. You can even try tummy time on your chest or lap before transitioning to a blanket on the floor.

Hold your baby often

Varying up how you hold and carry your baby throughout the day helps distribute pressure more evenly. It also encourages them to turn their head both ways to explore the world around them.

Here are a few easy ways to vary things up:

Switch arms during feeds. For bottle-fed babies, alternate arms with each feeding so your baby alternates the direction they turn to look at you. For breastfed babies, feeding on both breasts naturally varies head position.
Try babywearing while awake. Carrying your baby in a sling reduces the time spent on their back and evenly distributes pressure on the head — while also increasing bonding time.
Hold your baby upright. Hold your child upright on your shoulder and cuddle in different positions throughout the day to balance pressure. You can try the “football hold” or hold your baby facing outward to look at the world around them.

Limit time in car seats and baby carriers

Car seats are essential for travel, but they’re not meant for routine naps or long stretches of time at home. Extended time in car seats, swings and bouncers keep your baby’s head in a fixed position, increasing pressure on one area of the skull.

“Instead, plan frequent position changes throughout the day,” says Ms. Scheeler. “Rotate between tummy time, being held, wearing baby and short periods of playtime on their backs. If your baby prefers looking one way, place toys, books or even your face on the non-preferred side during play to encourage turning that way.”

Flat head syndrome: When to talk to a pediatrician

During routine checkups with your pediatrician, discuss concerns about your baby’s head shape, especially if you notice a flat spot becoming more noticeable after about 2 months of age or if your baby consistently looks in one direction. The skull responds most to change in the first 6 months, so early evaluation is important.

Your pediatrician may recommend a repositioning plan at home, show you gentle stretches for neck tightness or refer your baby to pediatric physical therapy to help strengthen neck and shoulder muscles.

Most cases of flat head syndrome can be improved with positional techniques at home. But if flattening remains significant despite repositioning and therapy, your pediatrician may refer you to a craniofacial specialist to discuss helmet therapy. Helmets are recommended for more severe cases and are most effective when started between 4 and 8 months, while head growth is still rapid.

“Safe sleep is a priority, but you can rotate head positions, add in tummy time and vary up holding and play positions while baby’s awake,” says Dr. Brimley. “Over time, small, consistent habits add up to help your baby’s skull grow more evenly.”