10691 Plagiocephaly Flat Head Syndrome

Overview

Plagiocephaly, often called flat head syndrome, is a condition where a baby’s head develops a flat spot on one side or the back. It happens when a baby spends a lot of time lying in one position, and the skull, which is still soft, becomes flattened. It is not dangerous to the brain and often improves with simple measures.

Yes, very common. It has become more frequent since doctors began recommending that babies sleep on their backs to prevent sudden infant death syndrome (SIDS).

It mainly affects infants, especially during the first few months of life. Babies of all genders and ethnic backgrounds can develop it.

Symptoms

Common symptoms

• A flat spot on the back or side of the head
• One ear sits slightly more forward than the other
• The head looks uneven or asymmetric from above
• The baby prefers to turn the head to one side
• A mild stiff neck (the baby may find it easier to look one way)

Symptoms in children

• A flat head shape that may become less noticeable as they grow
• Sometimes a mild facial asymmetry, such as one cheek appearing fuller
• No other symptoms in most cases

Symptoms in older adults

• Flat head syndrome is rare in older adults, and the condition itself causes no specific symptoms.
• If a head shape change appears later in life, it could be due to something else, like injury or bone changes, and should be checked by a doctor.

Causes

Main causes

• Positional molding – spending a lot of time lying on the back or on one particular side of the head
• Pressure inside the womb during pregnancy, especially if the womb is tight or there is little amniotic fluid
• Prolonged use of car seats, prams, or baby swings where the head rests against a firm surface
• Torticollis – a tight or shortened neck muscle that makes the baby prefer one head position

Risk factors

• Being the first child (the womb is tighter)
• Multiple birth (twins, triplets) – less room and more pressure in the womb
• Premature birth – the skull is softer
• Low birth weight
• Long labour or assisted delivery with forceps or vacuum

When to see a doctor

See a doctor urgently if:

• If you notice a very rapidly changing head shape
• If the soft spot (fontanelle) feels tight or bulges
• If your baby has a seizure or shows signs of a high fever

Book a routine appointment if:

• Mention any concerns about head shape at your baby’s routine health checks
• Ask for advice if your baby always turns their head to the same side or you feel the neck seems stiff

Diagnosis

Doctors usually can diagnose plagiocephaly by looking at and gently feeling your baby’s head from above and from the side. They will also check your baby’s neck movement and how they hold their head.

Tests that may be done

• Usually no tests are needed.
• If the shape is very unusual or the doctor suspects early closure of the skull bones (craniosynostosis), they may order imaging, such as a skull X-ray or CT scan.

What to expect at your appointment

The appointment is quick and painless. Your doctor will talk with you about safe sleeping positions, tummy time, and what to watch for. Most babies are diagnosed by a general practitioner (GP), health visitor, or pediatrician.

Treatment

The vast majority of cases need no medical treatment. Simple positioning changes, increased tummy time, and varying your baby’s head position during sleep can usually help the head round out over time.

Self-care at home

• Give your baby several short sessions of tummy time each day while they are awake and you are watching.
• Alternate your baby’s head position each time you put them down to sleep – for example, left side at one nap, right side at the next.
• Change the direction your baby faces in the cot or crib to encourage them to look different ways.
• Hold your baby upright more often to take pressure off the back of the head.

Medical treatments

No medicines treat flat head syndrome. If the flattening is severe or doesn’t improve with repositioning, a specialist may, in some cases, suggest a custom-made helmet or band. This is not a routine treatment and is best discussed with a pediatric specialist. Helmet therapy is generally not recommended for most younger babies.

When is surgery considered?

Surgery is very rarely needed. It is only considered for a different, more serious condition called craniosynostosis, where the skull bones close too early. Positional plagiocephaly almost never requires surgery.

Living with this condition

Living with flat head syndrome is about making small changes to how you position your baby throughout the day. Most babies’ heads naturally round out as they grow, especially once they start sitting up and crawling. Regular check-ups can help you feel confident things are on track.

Lifestyle tips

• Encourage supervised tummy time from an early age, starting with a few minutes a day.
• Avoid keeping your baby in car seats, prams, or bouncers for long stretches when not travelling.
• Change the position of toys and mobiles to prompt your baby to turn their head in each direction.
• Carry or hold your baby in an upright position when you can.

Diet and exercise

For babies, normal feeding and growth are most important. For older children and adults with a flat head shape from infancy, exercise and daily activities are not usually affected in any way.

Mental health and emotional wellbeing

It is natural to worry about your baby’s appearance, but it helps to know that flat head syndrome does not affect the brain or development. If you feel anxious, talk to your GP, health visitor, or another parent who has been through the same thing.

Prevention

Often, yes. You can reduce the risk of positional plagiocephaly by giving your baby supervised tummy time during wakeful hours, alternating head positions when they sleep, and not letting them spend too long in car seats or swing chairs when you’re not travelling.

Vaccines

This is not a condition that is prevented or affected by vaccines. However, keeping up with routine childhood vaccinations is important for your baby’s overall health.

Screening programmes

There is no formal screening programme, but health visitors and doctors routinely check head shape during well-baby visits.

Complications

If left untreated

• Usually there are no complications other than the aesthetic appearance of a flattened head.
• If the flattening is caused by craniosynostosis (early skull fusion) rather than positional plagiocephaly, pressure could build in the skull if left untreated – but this is rare.

Long-term outlook

The outlook is very good. Most babies’ head shapes improve significantly with simple measures and as they grow. Even if some flattening remains, it is usually minor and does not cause any health problems. For the small number of babies who need more help, helmets or other treatments are effective. There is no reason to worry about long-term harm in the vast majority of cases.

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