Why Some Babies Develop Flat Head On The Back or Side? Learn How Plagiocephaly is Treated

Why Some Babies Develop Flat Head On The Back or Side? Learn How Plagiocephaly is Treated

Shweta, a mother of three from New Delhi recalls the first time when she realized her 3 months old son head appeared unusual or misshaped. One day the boy was lying on his stomach i.e. tummy time or prone position and she noticed that the back of his head looked flat. Till that age, Shweta didn’t observe much of it as the boy has been sleeping on his back and there were hairs on his head.

Soon it started becoming obvious for both Shweta and his husband. On contacting the paediatrician it was confirmed that the boy was suffering from plagiocephaly or flat head syndrome.

Flat head syndrome

Plagiocephaly or better known with the term flat head syndrome, is a condition that occurs when an infant develops flat spot at the back or side of the head. This may cause the baby’s head to appear asymmetrical which is why sometimes the condition is also called as cranial asymmetry.

The condition is fairly common as against the frightening name of the condition. And though typically it’s not a serious condition, it does require treatment in some cases.

What are the types of flat head syndrome?

There are basically two types of flat head syndrome or plagiocephaly; one is the positional plagiocephaly and the other one is congenital plagiocephaly.

Positional plagiocephaly

It is also known as deformational plagiocephaly and the most common form of flat head syndrome. As per American Academy of Family Physicians, this type of flat head syndrome affects about 50 percent of babies.

Congenital plagiocephaly

This type of flat head syndrome is also called as craniosyntosis. It rarely occurs in about every 2000-2500 births and it’s a kind of birth defect. In this condition the fibrous spaces or sutures located between the skull bones closes prematurely. This leads to head becoming abnormal in shape.

Causes – How babies develop flat head syndrome?

Normally, skull bones of the baby do not completely fuse and toughens until several months following the birth. These soft, flexible bones are malleable means they can become out of shape without breaking or cracking. This is also necessary as the child has to pass through birth canal during delivery. So, due to some reasons, these soft bones become misshaped or distorted.

Congenital plagiocephaly is believed to occur during the development of the fetus. It can also be inherited from parents or part of many other genetic disorders. According to Indian Journal of Human Genetics, there are over 180 syndromes that can be linked to congenital plagiocephaly.

While plagiocephaly can occur due to:

Sleeping position

Putting the baby to sleep daily in the same position such as on their back or head facing left or right, can put consistent pressure on the internal parts of the skull, resulting in flat head.

Less time spent on the stomach

If your baby spends more time on his back then there are high chances of developing plagiocephaly. Maintaining the balance between the tummy time (lying on stomach or prone position) and lying on back can reduce the risk.

Twins or multiples

If you are carrying twin or multiples, there would be lack of space in the womb. This may put the baby’s skull at the risk of compression, resulting in plagiocephaly.

Delivery through forceps or vacuum

There might be situations when the doctor may choose forceps or vacuum to deliver the child. This can lead to misshaped head.

Being premature

Babies who are born before their term usually have softer bones as compared to full term babies. This will also require longer stay in hospital as preterm babies need neonatal care where they would spend plenty of time lying on their back. Due to all these reasons, positional plagiocephaly is much more common in preterm babies as against full-term babies.

Muscular torticollis

Many a times there is limited amount of space in the womb or often the baby is in breech position. This causes stiffness and imbalance in neck muscles of the infant, making harder for the babies to move their head. This may lead to skull deformity.

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Complications – Is flat head syndrome dangerous?

Most cases are not cause of concern and the condition improves on its own as the child gets older and start crawling, sitting and standing on her own. The condition doesn’t affect the brain development and is more of a cosmetic issue rather a medical one.

In a study conducted on 200 babies in 2004, the occurrence of positional plagiocephaly according to age was:

  • 4 weeks – 16 percent
  • 4 months – 19.7 percent
  • 1 year – 6.8 percent
  • 2 years – 3.3 percent

This shows, this condition is more common or more obvious in the first 4-6 months.

Signs and symptoms – How can we identify flat head syndrome?

It might take several months to spot the signs of this condition. You need to specially check the signs during baby’s bath when hair is wet and the shape is mostly visible. Check for signs such as:

  • Back area of the head appearing flat or slanted in some area instead of round
  • One side of the head appearing normal while other appearing flat
  • Hard edges on the skull
  • Less hair in one side of the head
  • Misaligned ears

Diagnosis of flat head syndrome

The earlier this condition is spotted, the better the chances of resolving it. You need to be pretty active in this matter as signs start becoming apparent when the babies are about 6-8 weeks. Though, during every routine checkup in infancy, many pediatricians physically examine the skull deformities, yet if it becomes apparent to you anytime, you must inform the doctor immediately.

The doctor can also check for any neurological or physical abnormalities.

Is flat head syndrome treatable?

The type of treatment will depend on cases to case and seriousness of the deformity. In many cases, the issue can be resolved just by changing the position of the baby at home. Below are the most common methods used to treat flat head syndrome:

Change of position

Prefer changing position of your baby regularly. For instance, if the baby prefers to sleep on their right cheek against the crib mattress, turn their head on their right cheek

Stretching exercises

The doctor may suggest stretching exercises in case of muscular torticollis to increase the range of motion of the baby’s neck.

Molding helmet therapy

In some other cases, the doctor may recommend a custom-molded helmet for the baby. Wearing this helmet day and night will steadily reform the skull and make it symmetrical in shape in about 12 weeks of time.


Surgical procedure isn’t needed if the type of plagiocephaly is positional. It’s only required in case of congenital type when sutures are closed and there is need to release the pressure in the skull.

Can we prevent flat head syndrome?

All the cases aren’t preventable but there are certain measures you can adopt to reduce the risks of getting positional plagiocephaly. These include:

  1. Frequently changing the sleeping position of the baby. Avoid letting her spend too much time in one position.
  2. Give your baby adequate tummy time under your supervision. Start with 3-5 minutes per session, 2-3 times a day. Increase the time steadily to 40-60 minutes per day.
  3. Use a baby carrier that will allow your baby to face towards your chest. The motive is to hold your baby upright as much as possible.
  4. Try to change feeding positions, for example if you are bottle feeding your baby while they on your right arm, change to the left.


Flat head syndrome or plagiocephaly is pretty common in infants. While it may appears like a serious condition of head deformation, the effects are typically mild and resolve as and when the baby grows and moves on its own. The condition does not causes any effects on the brain development, many cases resolve automatically without medical intervention.

However, you still need to be careful about any changes occurring on the body of your little one and report it to the pediatrician.


1. Plagiocephaly. read more
2. Plagiocephaly (flat head syndrome). (2016). read more
3. Positional skull deformity. 
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