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About plagiocephaly or flat head

Plagiocephaly is an uneven or asymmetrical head shape - a 'flat head'. It can also be a flattened spot on the back or side of a baby's head. Plagiocephaly can be mild, moderate or severe.

Babies are often born with misshaped heads. This can be caused by the head's position in the uterus during pregnancy, or it can happen because of the squashy passage down the birth canal.

Also, newborn skull bones are soft, thin and flexible. This means that the heads of newborn babies can change shape easily. So plagiocephaly sometimes happens when babies lie with their heads in the same position for a long time.

In some babies, more severe plagiocephaly can be caused by tight neck muscles (congenital muscular torticollis), which means babies have a strong preference for turning their heads to one side.

Later in infancy, some babies with severe plagiocephaly might have a delay in the development of gross motor skills like rolling and crawling.

The proper medical name for this type of plagiocephaly is deformational plagiocephaly. There's another type of plagiocephaly called synostotic plagiocephaly. It happens when a baby's skulls bones don't close properly. This article is only about deformational plagiocephaly.

Signs and symptoms of plagiocephaly

Your baby might have an uneven head shape, a flat head or flattened sections at the back or side of her head. Your baby's ears might look uneven, and her forehead might be more prominent compared to the rest of her head.

Does your child need to see a doctor about plagiocephaly?

See your GP or child and family health nurse if:

  • your baby has a strangely shaped head or a flat spot, which hasn't gone back to a normal shape by about two months of age
  • your baby has a strong preference for turning his head to one side, or has difficulty turning his head
  • you're concerned about your baby's head shape.

Treatment of plagiocephaly

Often, mild plagiocephaly doesn't need treatment. It's likely to fix itself as your baby grows.

This is because your baby's head shape will naturally improve as her head grows and her gross motor skills develop. When your baby starts to spend less time on her back and more time on her tummy or sitting, there'll be less pressure on the back of her head.

If your baby needs treatment, your GP or nurse might recommend you see a paediatric physiotherapist, paediatrician or plastic surgeon, who'll develop a treatment plan.

Treatment might include:

  • repositioning your baby so he avoids lying on the flat head spot when awake
  • doing gentle exercises and stretches with your baby to improve his neck movements
  • encouraging motor skills like rolling, reaching and turning
  • giving your baby tummy time and time on his side when he's awake
  • carrying your baby in certain ways - your health professionals will advise you.

For severe plagiocephaly, your specialist might recommend that your child wears a specially fitted helmet, which takes the pressure off the flat spot and allows your child's head shape to improve as her head grows.

It won't help to take your child to a chiropractor for back or neck adjustments.

Plagiocephaly prevention

There are several things you can do to help prevent your baby from developing plagiocephaly:

  • Try to alternate your baby's head position between right and left when he's sleeping on his back.
  • When using the change table or cot, alternate the end at which you place your baby's head.
  • When your baby is awake, give her tummy time or time on her side during supervised play.
  • Stimulate your baby - for example, talk, sing or shake a rattle - or put toys near your baby on the side he likes least. This will encourage him to turn his head to that side.

Positioning your baby on her back for sleep is the safest sleeping position. Putting your child to sleep on her stomach or side increases the risk of sudden unexpected death in infancy (SUDI).


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