Plagiocephaly (A.k.a. Flat Head Syndrome)

Everything you need to know about flat head syndrome, from how to identify it, to how to handle it once it happens.
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profile picture of Jennifer L.W. Fink
Registered Nurse
March 2, 2017
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What is plagiocephaly?

Plagiocephaly is sometimes known as “flat head syndrome.” You probably know a baby or two who has this. It’s a flat spot on baby’s head that doesn’t go away.

What are the symptoms of plagiocephaly in babies?

They’re exactly that — the flat spot. While some babies have funny-looking heads after birth, they usually become rounded pretty quickly. Plagiocephaly is a flat spot that stays flat.

Are there any tests for plagiocephaly?

Plagiocephaly can typically be diagnosed by a physical exam, but baby’s doctor may refer you to a specialist for additional testing and assessment. “There are a number of medical conditions that can cause unusual head shapes,” says Natasha Burgert, MD, FAAP, a pediatrician at Pediatrics Associates in Kansas City, Missouri. “That’s why consultation with a specialist is sometimes needed.”

How common is plagiocephaly in babies?

More common than it used to be. Healthcare providers noticed an uptick in the number of babies with flat heads after the American Academy of Pediatrics launched its “Back to Sleep” campaign in 1992, which was meant to help prevent SIDS. Before that, many (if not most) American babies slept on their stomachs, and flat heads were rare. After babies began routinely sleeping on their backs, the incidence of plagiocephaly increased. Today, as many as 13 percent of American babies have plagiocephaly.

How did my baby get plagiocephaly?

Most likely, it was caused by positioning. Because babies’ skulls are so flexible, a baby who spends too much time lying in one position may develop a flat spot on the side of his head that rests on the mattress.

Babies who spend a lot of time in car seats, swings and infant seats are also more likely to develop plagiocephaly, since infant seats and swings restrict head movement.

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Premature babies are especially prone to plagiocephaly because their skulls are even softer at birth than those of full-term babies.

What’s the best way to treat plagiocephaly in babies?

Treatment depends on how severe baby’s flat head is. Mild cases of plagiocephaly can be treated with repositional therapy, which basically means changing your baby’s position often enough that his head eventually rounds out on its own. Instead of always lying him in the same place in his crib, have his head pointing toward the head of the crib at naptime and toward the foot of the crib the next time you put him down. Use infant seats sparingly, and give baby as much tummy time as possible. Hold your baby frequently (that one’s pretty easy!).

In moderate to severe cases of plagiocephaly, specialized helmets can be used to reshape the head. Treatment usually starts between four and six months of age. Helmets are custom-fitted to the child and must be worn 23 hours a day. The helmet is usually worn for two to six months.

What can I do to prevent my baby from getting plagiocephaly?

Don’t let baby lie or sit for extended periods of time. “Remember the importance of tummy time,” Burgert says. “People tell me all the time that their baby hates tummy time, but we underestimate the variations of tummy time. Carrying your baby as you walk around the house counts. Holding your baby against your chest as you watch TV counts. Anything that gets them off the back of their head counts. You should be doing that for as many of your baby’s waking hours as you can.”

It’s still very important to put your baby to sleep in his back, though. Back sleeping has been shown to drastically reduce the risk of Sudden Infant Death Syndrome (SIDS), and it’s worth doing, even if it slightly increases your baby’s risk of developing a flat spot on his head. As a preventative measure, try laing your baby in a slightly different spot in the crib each time you put him down. The different positions will encourage him to move his head and decrease the risk of plagiocephaly.

What do other moms do when their babies have plagiocephaly?

“We noticed our daughter had mild plagiocephaly around two-months-old. She’s an excellent sleeper and from what I’ve read this makes plagio a little more likely, since sound-sleepers don’t switch positions much. We did repositioning, and I wore her as much as I could, and as she got bigger packed her in the exersaucer with rolled blankets and had her in the Bumbo. She is now four-months-old and we have definitely seen improvement.”

“My son had mild plagiocephaly. No helmet, but about four months of physical therapy.”

“My baby had moderate to severe plagiocephaly and we chose to helmet (DOC band) when he was eight-and-a-half-months old. They typically wait until around six months to helmet, so the child has good neck control. It was seriously no big deal, aside from an appointment every two weeks to resize it. It didn’t change his sleep, play, or eating at all. He wore it for just under four months and I am so, so, so happy with the results!”

Are there any other resources for plagiocephaly in babies?

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Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

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