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How Do I Fix A Flat Head?

newborn head
Are flat spots on the back of a baby's head normal?

Updated July 7, 2015

Since the launch of the Back to Sleep campaign in 1994 (now called Safe to Sleep), there has been an increase in the number of babies with flat spots on their heads, a medical condition known as positional plagiocephaly. In 1992, researchers found that placing babies on their backs when putting them down to sleep reduced the risk for sudden infant death syndrome (SIDS), the leading cause of death in infants between the ages of 1 month and 1 year. Since then, the rate of babies who are sleeping prone (face down) has decreased from 75 percent to 11 percent, and the rate of SIDS has declined nearly 60 percent. At the same time, however, there has been an increase in the number of babies with flat heads. One study of more than 400 Canadian infants ages 7 to 12 weeks found that nearly half—47 percent—had flat spots on their heads. (Note that positional plagiocephaly, which is caused by factors such as “back to sleep” or hard sleep surfaces including infant car seats and swings, is not to be confused with flat spots caused by craniosynostosis, a congenital condition that requires early diagnosis and treatment.)

A baby’s brain is not fully developed at birth; it continues to grow and reaches 80 percent of its adult size when a child is about 2 years of age. To allow for this growth, a baby’s head or skull is made up of soft bones that grow together and harden over time—this process usually takes about 12–24 months. If a baby spends a lot of time on her back (or consistently lies on one side or the other), a flat spot can form on her head. Little or no hair may grow on those spots. Once the baby starts to roll over, sit up, crawl, and walk, the flat spot will usually disappear and hair will grow back. In rare cases, the baby’s head can become severely misshapen.

Traditional therapy for plagiocephaly required the baby to wear a special helmet, molded to fit her head, for about 23 hours each day between the ages of 4–6 months. This therapy is still recognized as appropriate according to the American Academy of Pediatrics’ (AAP) latest guidelines for prevention and management of plagiocephaly. However, a randomized controlled trial of infants with flat spots in the Netherlands found that helmet therapy did not improve the child’s skull shape, when examined at 24 months of age. While the study had several limitations (small sample size and self-reported compliance with the length and duration of helmet therapy), the researchers found no significant differences in terms of babies’ head shape, parent satisfaction, child sleep, or other factors. The researchers recommended that parents and providers forgo helmets as standard treatment with healthy children and instead focus on prevention, early detection, and other treatments.

Parents can aid healthy skull development by:

  • Practicing kangaroo care (skin-to-skin care). Especially important for premature babies, who are at increased risk of plagiocephaly (their heads are even softer than those of full-term babies, and they tend to spend more time in their cots, lying on their backs), but also important for full-term babies. Parents (moms and dads alike) should hold their baby skin-to-skin against their chest (“kangaroo care”) or carry her upright in a sling or other type of infant carrier.
  • Making the most of tummy time. Putting your baby on her tummy when she is awake can also help to reduce your baby’s risk for flat spots. (“Tummy time” will also strengthen the muscles needed for crawling and sitting.) Because the risk of SIDS is greater when babies are on their tummies, parents are encouraged to never leave a baby alone during tummy time. If you need to leave your baby alone, even for a minute or two, turn her onto her back. You can place her on her tummy when you return.
  • Continuing “back to sleep.” Put your baby to sleep on her back during naps and at night. Despite the increased risk for flat spots, the AAP continues to recommend placing infants on their backs to sleep to greatly decrease the risk for SIDS. Parents should also avoid keeping infants in car seats or swings for long periods of time.
  • Alternating the position of the head. To reduce your baby’s risk for developing a flat spot, alternate which direction you place her on the mattress. (Babies tend to turn their heads toward an object of interest, such as a mobile or a light source; by alternating her positioning, she may naturally change the direction of her head without you having to force her head to rest on any particular side.)

For more about positional plagiocephaly, see the AAP guidelines, Prevention and Management of Positional Skull Deformities in Infants, published in the December 2011 issue of Pediatrics.

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