Plagiocephaly: Why Some Babies Develop Flat Spots and What to Do About It

By Lindsey Johnson

Plagiocephaly is the medical term to describe a attened area on a baby’s skull. This condition is sometimes referred to by physicians as “Flat Head Syndrome” and may impact up to 46% of healthy infants, according to Boston Children’s Hospital.


In 1992, the American Academy of Pediatrics (AAP) began recommending back sleeping in order to reduce the incidence of Sudden Infant Death Syndrome (SIDS). While this campaign has reduced infant mortality from SIDS, it has increased the incidence of plagiocephaly.


Positional plagiocephaly is the most common form. is is typically a result of extended periods of pressure on one area of the skull.

Congenital plagiocephaly, or craniosynostosis, is a birth defect where the skull bones fuse too early. As a result, the skull is unable to grow properly and may cause a misshapen head.

Causes and Risk Factors

Back sleeping, extended time in car seats, swings and bouncy seats can contribute to the formation of a at spot.

Muscular torticollis is tight muscles in the neck present at birth that limit the head’s range of motion. When the neck cannot fully pivot, the head remains in the same position.

Premature infants may also be more likely to develop plagiocephaly. e skull bones are softer and many premature babies spend an extended period on their backs hooked up to respirators.

Johns Hopkins Medicine reports that rst-born children, males, and infants born with the assistance of birthing instruments may also be at increased risk for plagiocephaly. Duke Health states that twin births may also be at higher risk.


The first line of defense for positional plagiocephaly is reducing the amount of time the baby spends lying down. Limiting time in devices such as car seats, bouncy seats and swings is one approach. Creating ample opportunities throughout the day for the baby to experience supervised “tummy time” will strengthen neck muscles and limit time spent resting on the head. Increasing time snuggling the baby upright to the chest will also help strengthen neck muscles. Repositioning therapy with intentional positioning of the head in a di erent direction can also help. Some parents change the direction the baby lies in the crib, creating alternate views of the door and window to encourage head movement in new directions.

In the case of torticollis, the pediatrician may refer the infant for physical therapy to release the tension in the neck and increase neck strength.

For moderate to severe cases, some specialists may recommend an orthotic helmet, specially designed to the dimensions of the baby’s head. The helmet includes a hard outer shell with a soft foam lining on the interior. According to the American Association of Neurological Surgeons (AANS), babies who begin orthotic treatment between ages 3-6 months will typically complete therapy within approximately 12 weeks.

Infants born with craniosynostosis are at risk for increased pressure in the head and limited space for brain growth. Treatment may include an orthotic helmet or surgery to open skull sutures to allow room for normal brain growth.

Plagiocephaly is a common occurrence in infants. While it may cause alarm among parents, most cases are not severe and are easily corrected with simple techniques. Consult your pediatrician if you have concerns about your infant’s head development.

From a Mom Who Has Been There!

“Lucas had plagiocephaly at birth due to a dif cult delivery leading to an urgent C-section. Newborns’ heads are very malleable and we need to be gentle, especially prior to closure of the “suture” lines. We noticed that his right side of the head was becoming atter over the months and according to measurements at the Hanger Clinic, it was shifting his right forehead, eyebrow and ear more forward, possibly leading to right ear issues as he gets older. There is controversy as to whether helmet therapy is necessary or not. However, meeting with a diverse team including physical therapy, orthotics specialist, pediatrician and possibly neurosurgeon if needed can be crucial for determining what is best for your child, as well as considering cost. Many resources are available for home exercises, neck support when transitioning from tummy time to laying down positions and many social support groups online.

Luckily we had treatment during the winter months from Halloween at 6 1/2 months to January 2020 at 9 months old, so he had less skin irritation on his face and scalp with less sweating than if he had done it during the summer. Our experience with Kyra at Hanger Clinic was amazing and he became our little “space cadet” for a few months. We still have our helmet for the memories. He is now 2 years old and doing well!”

– Ashley Mudra, mom to Lucas


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