What is meant by the term 'flattened head'?

A flattened head means a baby’s head is unusually shaped and may appear flat or asymmetrical. Most commonly, flat areas develop on the back or sides of a baby’s head because of pressure. This flattening, called positional plagiocephaly, can be more obvious in babies without much hair.

Other names for a flattened head shape are plagiocephaly, brachycephaly or misshapen head.

What is typical for a baby's head when they are born?

It’s common for newborns to have an unusual shaped head. This is because the bones in their skull are soft and not fully formed. It allows their head to be easily moulded to help with birth. The skin-covered gaps where the skull plates meet are called fontanelles, and if you touch the top of your baby's head you can feel these 'soft spot' in between the bones.

A baby’s position in the uterus, type of birth and even the length of labour can all influence the shape of a baby’s head when they are born. Generally, a baby’s head returns to more of a usual shape within 6 weeks after birth.

What are the causes of a flattened head?

The bones in a baby’s head are thin and flexible, making their head soft and prone to changing shape. When a baby is spending a lot of time lying down, the weight of their head can also make it hard for them to move around. Babies have limited neck movement and head control, and this combination of pressure and resting in the same position often leads to a flat area on their head.

Some babies are more prone to developing a flattened head because they aren’t very mobile or it’s hard for them to lift their head. Babies who have torticollis (when the neck muscles are shortened on one side) are more at risk of plagiocephaly.

How is a flattened head treated?

Most babies don’t need any special treatment for a flattened head, especially if they are becoming more active and learning how to sit up. Sitting on a parent’s lap and learning how to hold their head up, rather than always having their head supported by pressure from the cot mattress or floor makes a big difference.

Once there is a lessening of pressure on the same area on their head, the flattening tends to ease and the head shape becomes more rounded. In the meantime, it’s important to give your baby lots of opportunity to move around so they don’t spend so much time lying in the same position.

• Offer your baby tummy time every day. From birth and when your baby is awake, place them on their tummy on a rug on the floor. Supervise them and stay close.
• Change your baby’s position when they’re having tummy time and try to also place them on their side, taking turns with both sides for as long as they’re happy.
• Hold your baby in different positions in your arms so they aren’t always turning their head in the same direction to look at you.
• Hold your baby so they are looking outwards and have the opportunity to build their neck and upper body strength. Hold them over your arm, or on their side so they’re looking outwards, not always towards you.
• Change the position of your baby’s cot so they aren’t always on the same side as they look out through the cot rails. If moving the cot isn’t possible, alternate the end of the cot in which you place your baby for sleep.
• Give your baby the opportunity to turn their head themselves when they are awake. Use your face and voice, brightly coloured toys and books with pictures to get their attention so they turn their head both ways.

Specialist treatment for a flattened head

Occasionally, specialist treatment is necessary to treat a flattened head. Generally, assessment starts with a physiotherapist who will recommend active exercises and strategies on positioning to improve head shape. Sometimes referral to a paediatrician, plastic surgeon or orthotist is needed.

A small number of babies (less than 1 in 10) with plagiocephaly will have a deformity of their head shape and need to be fitted with a helmet. Helmet therapy helps to reshape the skull by taking pressure off the flat area and allowing the skull to grow into the space provided.

How can I prevent my baby from developing a flattened head?

It’s important to vary your baby’s position both when they are sleeping and when they’re awake to help prevent a flat area developing on their head.

Remember to:

Always follow the safe sleeping guidelines and place your baby on their back to sleep.

What not to do when settling your baby

Don’t use pillows, bumpers or sleeping devices which keep your baby in the same position in their cot. It’s important that they learn to move around and aren’t restricted.

Will there be any lasting effects from my baby’s flattened head?

Plagiocephaly does not affect brain development. However, it can influence a baby’s appearance because of uneven growth of the face and head.

Who can I see for information and advice?

Speak with your child health nurse and GP if you are worried about the shape of your baby’s head. Often, changes in a baby’s position will make a difference. If needed, you’ll be referred to a physiotherapist who can assess the degree of head flattening and recommend treatment.