Noticing that your baby’s head looks flatter on one side, or different from how you expected, can be unsettling. It is natural to wonder whether it is something to worry about, whether you have done anything wrong, and whether their head shape will improve as they grow.
Flat head syndrome is common in babies and is often related to the positions they spend time in while their skull is still soft and developing. In most cases, it is not harmful, but understanding what you are seeing can make it much easier to know what to do next.
This guide explains the different types of flat head syndrome, why they develop, the signs to look for and the simple changes or treatments that may help.
Understanding flat head syndrome
Flat Head Syndrome, or plagiocephaly, is a common condition in babies in which part of the head becomes flattened, or the shape looks uneven. The word plagiocephaly comes from Greek: plágios meaning oblique or slanting, and kephalē meaning head.
For most babies, positional Flat Head Syndrome is not harmful and does not affect the brain or development. The NHS explains that it will usually improve as your baby grows and spends less time lying down.
Causes of flat head syndrome in babies
A baby’s skull is still soft and developing, which means its shape can be affected by pressure and positioning. This can happen before or during birth, or in the months afterwards. Flat Head Syndrome is sometimes described as either primary or secondary plagiocephaly, depending on when the changes developed.
Primary Plagiocephaly
Primary plagiocephaly develops because of factors before or during birth. Before birth, these can include the baby’s position in the womb, a tight pelvis, a multiple pregnancy such as twins, or congenital muscular torticollis, where the muscles in the baby’s neck are tighter on one side. Your baby’s head shape can also be affected during birth. Factors can include the baby positioning themselves early, a prolonged labour, the use of obstetric devices or a Caesarean section.
Secondary Plagiocephaly
Secondary plagiocephaly develops after birth and can happen when the same area of the baby’s head is under pressure for longer periods. For example, a baby may prefer turning their head towards one side while sleeping or feeding, meaning the same area of the head regularly rests against a surface. Premature babies may also be more susceptible, particularly if they spend an extended period in a neonatal incubator with fewer opportunities to change position.
Plagiocephaly rates in the UK increased following the introduction of safer sleep advice in 1992, when parents were advised to place babies on their backs to reduce the risk of cot death (SIDS). This change made back sleeping more common and, as a result, babies began spending more time with pressure on the back of the head. Babies should still always be placed on their backs to sleep. Later in this guide, we explain how to reduce pressure on your baby’s head while still following safe-sleep advice.
Signs of flat head syndrome
The main sign of Flat Head Syndrome is a change in the shape of your baby’s head. You may notice that one side looks flatter than the other or that the back of the head appears flatter.
When plagiocephaly also affects the face and surrounding areas, there can be other differences, including:
- One eye appearing slightly different in position from the other
- One ear sitting slightly further forwards or backwards than the other, which in some cases may be associated with differences in hearing
- Some asymmetry around the mouth
- Difficulty using the mouth, including problems with sucking
- Differences in posture, including asymmetry through the body
These signs will not necessarily affect every baby. If you notice changes that concern you, an assessment can help you understand what is causing them.
Differences between Plagiocephaly and Craniosynostosis
Plagiocephaly and craniosynostosis can both change the shape of a baby’s head, but they happen for different reasons. With positional plagiocephaly, pressure on part of the skull changes its shape while the skull bones themselves continue to grow. The head may develop a more parallelogram-like shape, but the brain still has space to grow.
Craniosynostosis is different. It is a condition where one or more of the joints between the bones of a baby’s skull join earlier than they should. This can affect how the skull grows and, in some cases, increase pressure inside the skull.
Your baby’s head shape can offer clues, but you don’t need to diagnose it yourself. Craniosynostosis requires specialist medical assessment and treatment, so if you are concerned about your baby’s head shape, seek professional advice.
Treatment of flat head syndrome
The right approach will depend on how much your baby’s head shape has changed and what may be contributing to it. Milder cases of positional plagiocephaly can be treated with manual therapy alone. Where the changes are more pronounced, cranial orthotic aids may be used alongside manual therapy.
For osteopathic treatment, the first few months of a baby’s life are an important time to work with the condition, with treatment ideally beginning between birth and four months. Osteopathic treatment is gentle.
An osteopath uses careful, hands-on techniques to encourage movement in the skull’s structures and may also work with areas such as the sacrum and pelvis. Osteopathic treatment rarely completely returns the head to its original shape. Instead, a structured course of treatment aims to reduce asymmetry, improve movement, and address other symptoms your baby may be experiencing.
Osteopathic treatment may help to:
- Correct and limit changes to the shape of the skull
- Restore a comfortable range of movement
- Support balanced movement and development
- Help prevent future problems
- Supplement and enhance the effects of any medication
- Reduce asymmetry in the baby’s face
Treatment can be adapted to your baby and what the osteopath finds during their assessment.
Preventing flat head syndrome at home
You can do simple things at home to encourage your baby to move their head in different directions and reduce time spent with pressure on the same area.
Introduce tummy time early
Tummy time means placing your baby on their tummy while they are awake. It encourages them to use and strengthen their neck muscles while giving the back of their head a break from pressure. You can start tummy time from birth, beginning with short periods and gradually increasing the time as your baby gets used to the position. Always do tummy time while your baby is awake and supervised.
Continue putting your baby on their back to sleep
Place your baby on their back when it is time to sleep. Even if your baby has Flat Head Syndrome, the NHS advises continuing to put them on their back to sleep because this reduces the risk of sudden infant death syndrome (SIDS).
Don’t put your baby to sleep on their front or side to change their head shape. When your baby is awake and lying on their tummy, you can encourage them to turn their neck gently from side to side.
Pay attention to their preferred position
Notice whether your baby tends to look in the same direction. When they are awake, encourage them to turn toward the other side so they don’t keep resting or moving in one preferred position.
Alternate sides during feeding
Feeding from both sides can encourage your baby to turn their head in different directions rather than keeping it in the same position for long periods.
When to seek professional advice
Flat Head Syndrome often improves as a baby grows, becomes stronger and starts moving their head more independently. But if something about your baby’s head shape or movement concerns you, you do not have to wait and see.
The NHS recommends speaking to your GP or health visitor if you are concerned about the shape of your baby’s head, or if your baby has difficulty turning their head or consistently holds it tilted to one side.
Our Nordic Balance osteopaths have experience working with newborns and can assess your baby, answer your questions and advise you on whether osteopathic treatment may be appropriate.
If you are concerned about your baby’s head shape, book an appointment with our osteopathy team for personalised advice and support.
