Brachycephaly

Overview

Brachycephaly (say "brak-ee-KEF-uh-lee") is a condition where the back of the head looks flat and the head appears wider and shorter than usual. It is often called flat head syndrome. It can happen in babies when they spend a lot of time lying on their backs. Brachycephaly can also be a natural head shape in some people.

Yes, positional brachycephaly is very common. Many babies have some degree of flattening in their first few months, especially since doctors recommend that babies sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS).

Brachycephaly most often appears in babies under 6 months, because their skull bones are soft and they spend a lot of time lying on their backs. It can affect babies born early, twins or triplets, and babies with a tight neck muscle. It can also be a natural head shape in some families.

Symptoms

Common symptoms

• A flat spot at the back of the head
• A head that looks wider than normal
• Ears that look uneven when seen from above
• No pain or discomfort

Symptoms in children

• The same flat spot or wide-looking head shape
• A preference for turning the head to one side
• Possible neck tightness or difficulty turning the head fully

Symptoms in older adults

• Usually no symptoms — it is just the natural shape of the head
• If it is due to premature fusion of skull bones, there may be headaches or vision problems, but this is very rare

Causes

Main causes

• Pressure on the back of the head from lying on the back for long periods
• A tight neck muscle (torticollis) that makes a baby rest their head on the same spot
• Fused skull bones (craniosynostosis) — this is a rare cause
• Certain genetic conditions or syndromes that affect skull shape

Risk factors

• Back sleeping (recommended to reduce SIDS, but can cause flattening)
• Premature birth, when the skull is softer
• Limited tummy time during awake hours
• Long periods in car seats, bouncers, or baby swings
• Being a twin, triplet, or other multiple

When to see a doctor

See a doctor urgently if:

• A bulging soft spot
• Seizures
• Unusual tiredness or irritability
• Repeated vomiting

Book a routine appointment if:

• Your baby has a flat spot that is not improving after a few weeks of repositioning
• Your baby keeps tilting their head to one side
• You feel a firm ridge along the skull seams
• You simply want a professional reassurance about your baby’s head shape

Diagnosis

A doctor, health visitor, or nurse will look at the head from above and from the side, and gently feel the skull. They will also ask about your baby’s sleeping positions, tummy time, and how they move their neck.

Tests that may be done

• A physical examination of the head and neck
• Measuring the head circumference and tracking it over time
• Sometimes an imaging test (such as a CT scan) if craniosynostosis is suspected

What to expect at your appointment

At the appointment, the clinician will take a careful history, measure the head, check the soft spot, and watch how your baby moves their neck. Usually, you will get a clear explanation and practical advice right away.

Treatment

Most cases need no medical treatment. The main approach is to reduce pressure on the flat spot by changing your baby’s position often during awake time, giving more supervised tummy time, and using repositioning techniques. If there is a tight neck muscle, physiotherapy can make a big difference.

Self-care at home

• Provide plenty of tummy time while your baby is awake and you are watching
• Alternate the direction your baby faces when you put them down to sleep (always on their back)
• Hold your baby upright more often during the day
• Limit time in car seats, prams, and bouncers when you are not actually travelling
• Encourage gentle neck turns — ask a health professional to show you safe stretches

Medical treatments

If the flattening is moderate to severe or is not improving, a specialist craniofacial team may suggest a custom moulded helmet (helmet therapy) to help guide the head into a rounder shape. If the cause is craniosynostosis (fused skull bones), surgery by a craniofacial team may be discussed. There are no medicines used to treat head shape.

When is surgery considered?

Surgery is rarely needed. It is only considered when the skull bones have fused too early (craniosynostosis) and there is a risk of pressure on the brain. For the common positional brachycephaly, surgery is not performed.

Living with this condition

For babies, daily routines matter most. Use feeding, nappy changes, and playtime as opportunities to change head position. For older children and adults, brachycephaly usually does not affect everyday life at all.

Lifestyle tips

• Make tummy time a regular part of the day
• Use positioning to keep pressure off the flat spot
• Avoid keeping your baby in car seats or baby seats for long periods when not travelling
• Encourage face-to-face play from different angles

Diet and exercise

There is no special diet for brachycephaly. Normal feeding and a healthy, active start to life support overall development. For older children and adults, usual healthy living advice applies.

Mental health and emotional wellbeing

Parents often feel anxious or guilty when they notice a flat spot. It is completely understandable, but it is important to know that this is not caused by anything you did. Speaking with a health visitor, midwife, or GP can ease your worries. If an older child feels self-conscious, talk to a school nurse or GP for advice and reassurance.

Prevention

Positional brachycephaly can often be prevented or reduced by changing head position while your baby sleeps (always on their back), providing plenty of supervised tummy time, and limiting time in car seats and baby containers. Remember: always put your baby to sleep on their back — this is the safest position and should not be changed.

Complications

If left untreated

• For positional flattening: usually no health complications
• If caused by craniosynostosis and not treated: possible pressure on the brain, headaches, and vision problems
• If neck tightness (torticollis) is not addressed: your baby may keep a limited range of neck movement, though this often improves with physiotherapy

Long-term outlook

The outlook is very good, especially when brachycephaly is noticed early. Most positional flattening improves greatly within a few months with simple repositioning. Even if some flattening remains, it does not affect health, intelligence, or development. With support from your health team, you can feel confident about the future.

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