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Positional Plagiocephaly (Flattened Head)

Condition Basics

What are positional plagiocephaly and brachycephaly?

Positional plagiocephaly means that a baby's head is flat in the back on one side. Brachycephaly means that a baby's head is flat across the entire back of the head. Most often, it's from lying on the back or lying with the head to one side for long periods of time. Sometimes a baby's forehead, cheek, or ear may get pushed forward a bit on one side. You may hear this called flat head syndrome.

Positional plagiocephaly and brachycephaly don't hurt your baby. And in most children the flat area responds well to treatment, especially when we start early.

What causes it?

The shape of a newborn's head may be affected by how the baby was positioned in the uterus. It can also be affected by the birth process or by positions your baby spends a lot of time in.

Lots of time spent in cribs, car seats, carriers, or other seats may lead to a flat area on your baby's head. Torticollis, or "wryneck," can also lead to a flat spot on your baby’s head. It's a problem with your baby's neck muscles. It causes the head to turn to one side. If your baby has torticollis, your doctor may recommend neck exercises. These may help your baby turn their head.

How is it diagnosed?

Doctors, public health nurses, and physiotherapists can diagnose plagiocephaly and brachycephaly by looking at the shape of a baby's head. The doctor and physiotherapist will check to make sure that your baby doesn't have some other condition that affects the shape of the head.

How is positional plagiocephaly and brachycephaly treated?

Your doctor may recommend physiotherapy to treat plagiocephaly and brachycephaly. This is especially true if it's caused by problems with your baby's neck muscles.

Talk with your doctor or healthcare provider about how to position your baby so that you don't raise your baby's risk of sudden infant death syndrome (SIDS). Don't use sleep positioners or head-shaping pillows. Until your baby's first birthday, always place your baby on their back to sleep, even if your baby has a flat spot. Offer plenty of tummy time and cuddle time. And change your baby's head position when your baby lies down.

If your baby's head shape does not get better by around 6 months, let your doctor know.

If the head shape change is severe or other treatments haven't worked, your doctor may have you try a custom helmet. The helmet can help correct the shape of your baby's head. Surgery usually isn't done, except in rare cases.

How can you prevent it?

To help prevent a flat spot:

  • Provide plenty of tummy time while your baby is awake. This means letting your baby lie on their stomach while you watch closely. This helps your baby build strength and motor skills.
  • Provide plenty of cuddle time by holding your baby in an upright position.
  • Provide play time with your baby lying on their side. Position them with the round side of the head down on the floor. This will help the flat area to round out.
  • Change the direction your baby lies in the crib each night. This encourages your baby to turn their head a different way to look at things.
  • Change the location of your baby's crib in the room. This also encourages your baby to turn their head to look in a different direction.
  • Avoid having your baby spend too much time in car seats, carriers, or similar seats. But always put your baby in a car seat when they're riding in a car.
  • Do not use infant head-shaping pillows. Experts warn that these could be unsafe for your baby.


Adaptation Date: 12/13/2023

Adapted By: Alberta Health Services

Adaptation Reviewed By: Alberta Health Services

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