Since the American Academy of Pediatrics launched its Back to Sleep campaign in the 1990s and the more recent Safe to Sleep campaign by the Centers for Disease Control and Prevention (CDC), the rate of sudden unexpected infant deaths (SUID, also known as SID) has decreased by 50%. These initiatives have been instrumental in educating parents and caregivers about the importance of placing babies on their backs to sleep.
However, while researchers and health care providers have discovered that back sleeping helps reduce the risk of SUID, they have also observed a concurrent rise in cases of plagiocephaly, also known as flat head syndrome. This condition develops when an infant's soft skull becomes flattened in one area due to repeated pressure on the same side of the head.
What causes plagiocephaly (flat head syndrome)?
The most common cause of plagiocephaly is positional. This occurs when a baby spends too much time lying on one side of their head. While sleeping is the primary culprit, other factors can contribute to the condition, including prolonged periods spent in car seats, carriers, strollers and swings. Premature babies are at a higher risk due to their softer skulls and the extended time they may spend lying on their backs, especially if they required care in a neonatal intensive care unit (NICU).
Many parents may feel guilty or blame themselves for their baby’s flat head. However, it’s important to remember that most babies don’t have perfectly shaped heads. According to Michael Bradfield, MD, with Banner Health, "The most important thing to remember is that plagiocephaly is a reversible, nonsurgical condition, but it is important to be evaluated by a physician."
While positional plagiocephaly is common, other conditions can cause similar symptoms, including:
- Craniosynostosis: This is the premature fusion of the skull bones, affecting about 1 in 2,500 births. It includes types like trigonocephaly, scaphocephaly and brachycephaly. This condition usually requires surgical intervention, with or without helmet therapy.
- Congenital torticollis: Also known as wry neck, this condition occurs when one side of the neck muscle shortens, causing the head to tilt in one direction. Physical therapy can usually correct this condition if started early.
How is plagiocephaly diagnosed?
Your child’s pediatrician or primary care doctor will typically assess your baby’s head for signs like bony ridges, flat spots, an uneven forehead or facial asymmetry. "Medical tests are usually not needed," Dr. Bradfield explained. "However, if the diagnosis isn’t clear or if the condition doesn’t improve after six months of conservative treatments, your doctor may refer you to a neurosurgeon or craniofacial specialist."
Treatment options for positional plagiocephaly
In most cases, plagiocephaly improves over time. However, there are several approaches you can take at home, along with professional treatments that may be recommended.
What you can do at home
- Tummy time: Encourage your baby to spend supervised tummy time during awake hours. This helps reduce pressure on the skull and strengthens neck muscles. It's never too late to start tummy time, and a baby’s head continues to remodel until around 18 months of age.
- Hold your baby more often: While it may be hard for busy parents, holding your baby frequently can take pressure off their head. Avoid letting your baby fall asleep in a car seat or other sitting devices.
- Vary their sleeping position: If you always lay your baby down in the same direction in the crib or your arms, try changing their position to the opposite side to reduce pressure on one part of their head.
Important reminder: Continue to place your baby on their back for sleep. This is still the safest position to reduce the risk of sudden infant death syndrome (SIDS).
Physical therapy for flat head syndrome
In some cases, babies with plagiocephaly may also have mild torticollis (a neck muscle condition). A repositioning program, combined with physical therapy, can be very effective in helping your baby’s neck muscles lengthen and straighten, improving their head shape.
Orthotic helmets for plagiocephaly
While most cases of flat head syndrome can be treated with repositioning techniques and physical therapy, in some cases, a helmet may be recommended. Helmets are usually considered when these other methods haven’t been successful in correcting the shape of the head. If your doctor suggests a helmet, they will refer you to a certified orthotist who specializes in creating and fitting the device.
When to seek help
If you’re concerned that your baby may be experiencing plagiocephaly or a related condition, it's important to schedule an appointment with a pediatrician or one of Banner Health’s specialists. Early evaluation can help ensure that your baby receives the best care possible.
Recommended reading
- Torticollis: What to Do if Your Newborn’s Head Tilts to One Side
- Tummy Time: Why It’s So Important for Your Baby
- Is My Baby at Risk for Sudden Infant Death Syndrome, or SIDS?
Content in this article was updated on January 6, 2024.
