Helpful Guide to Flat Head Syndrome

October 9, 2013

What is Flat Head Syndrome?

Flat head syndrome is also called plagiocephaly and there seems to be more and more cases of it arising. You may notice a flattening on your baby’s head, possibly at the back or on one side. Their ears may appear crooked and their forehead uneven. There are different types of plagiocephaly, including:

Primary Plagiocephaly which develops whilst your baby is still in the uterus. Your body is your baby’s first home and if there are restrictions they can impact the moulding of your baby’s head as they grow. Primary plagiocephaly can also come about from a difficult labour, such as the use of forceps or ventouse physically moulding the skull.

Secondary [Positional] Plagiocephaly develops after your baby has been born and you may start to notice some flattening at around 6-8 weeks. It is called Positional Plagiocephaly because the flattening has often developed from the way your baby’s head is positioned.

 Why might my baby develop Positional Plagiocephaly?

Your baby’s skull is soft and made up of a number of bones, perfect for squeezing through the birth canal.  If your baby’s head falls predominantly to one side, they may start to develop a flattening as the bones are so soft. Tummy time is recommended to try and reduce the amount of time your baby spends putting pressure through those bones of the skull. But babies spend a lot of time sleeping on their back and if your baby’s head tends to fall to one side, the extra pressure may cause the bones to flatten.

Why might my baby’s head tend to fall to one side?

The bones of the skull are designed to be squashed as they pass through the birth canal, but not all births are as straightforward as one might hope. The use of forceps and ventouse might be needed to turn your baby or assist a delivery and this can cause stiffness in the upper joints of the neck or tightness in the muscles. If these don’t self-resolve, there is a significant chance your baby will develop positional plagiocephaly.  You may be advised to repeatedly turn their head to the opoosite side, but if the joint is restricted you may find it just falls back in to the old position once you have left the room.

Are there any signs my baby might develop a flat head?

When you spend each day gazing lovingly at your child you may not spot the early signs of flat head so ask someone close to you to look at your baby’s head and run their hands gently over it with their hands to explore the surface and you may see some of these early signs:

  • Does your baby prefer to turn their head more to one side?
  • When your baby lies flat on their back, do they lie straight or favour a banana-shape?
  • Do they struggle with breastfeeding from one side?
  • Do the ears appear level?
  • Do their eyes look the same size and shape?
  • Is their forehead protruding one side?
  • Is there any flattening on their head?

Most cases of positional plagiocephaly are preventable and recognising these early indicators and having a strategy in place to improve the biomechanics and pressures on your skull can help prevent or largely resolve positional plagiocephaly.



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Positional Plagiocephaly Myths!

As paediatric osteopaths we have seen many babies with positional plagiocephaly and met many distressed parents who have been misinformed about this condition. Some of the myths we have heard include:

  • MYTH: Your baby’s flat head will improve when they start sitting up
    • This would seem to make sense since it is supposed your baby will spend less time on their back when they start sitting. However, your baby will continue to sleep for more than 12 hours a day on their back and may continue to put pressure on their head for this time, further compressing the flattening.
    • MYTH: Your baby’s hair will grow and cover it
      • There is no denying your baby’s hair will cover the flattening, but it won’t hide the protrusion that may develop through your baby’s forehead which comes about from the flattening. It’s also worth considering the function of your baby’s skull rather than the aesthetics. The bones of the skull have lots of jobs, such as having holes to allow sinuses to clear and they make tunnels and canals to allow structures such as the ear canal to travel. If the bones have changed shape from flattening then these structures can change shape impacting the function and leading to problems later such as glue ear and sinusitis.

Tips to Prevent Positional Plagiocephaly

Many cases of positional plagiocephaly can be avoided with these small changes from birth. Prevention is far better than cure so here are our tips:


  • When your baby is asleep, gently turn their head to face away from the flattening
  • If their head springs back, roll up a muslin and tuck it under the flattening side to support it
  • Try a baby pillow. The Swedish Health department recommends that all newborn babies should sleep on their backs with a soft pillow to help reduce the possibility of developing plagiocephaly, but this is not currently a UK recommendation. There are a number of pillows on the market, look for a breathable product such as the Mimos Baby Pillow (


  • Ensure your baby is lying straight in the car seat and only use a car seat for the car
  • When using a sling, where possible, alternate the side your baby is looking


  • Play, sing and interact with your baby from both sides.
  • Babies often turn their head towards the light so position your baby accordingly to encourage them to look both ways
  • Tummy time helps strengthen the muscles of the head and neck, as well as helping the spinal curves develop. Many babies find tummy time upsetting initially, but use your imagination and you may find they start to enjoy it. If you have a swiss ball at home, try kneeling in front of it and hold your baby on the ball, rolling their tummy along the surface so they are facing you. Having eye contact with you can give them comfort and make this time more enjoyable.
  • Aim for a small moment of tummy time after each nappy change – little and often


  • If breastfeeding, ensure you feed from both sides. If it is painful on one side then seek the help of a lactation consultant who will assess your position and attachment.
  • If breastfeeding is painful on one side and there is no problem with your position or attachment then seeking the help of a paediatric osteopath may be beneficial to ensure the mechanics of the jaw, tongue and neck are functioning well.
  • If bottle feeding, switch sides at each feed to encourage neck movements both ways

Paediatric Osteopathy

If you are concerned about your baby’s head or neck, an assessment with an osteopath who specialises in children can help identify structural reasons why your baby may not be moving their neck as well as they might and this may help prevent them from developing plagiocephaly.

When should I be worried about my baby’s flat head?

If you feel your baby’s head is not growing, if there are any ridges on your baby’s head, or if there is some delay with their development, consult your GP. Brachycephaly is a different type of flat head which comes about through different reasons and may need further investigation. If you are in any doubt or need reassurance, contact your GP.

Should I get my baby a helmet?

Helmets can be helpful for children with extreme cases of positional plagiocephaly or positional brachycephaly but they can be invasive. If less-invasive and traumatic treatment plan can be found then a helmet may be unnecessary. Through repositioning, tummy time, small changes to daily activities and osteopathy substantial changes may be made.

Our osteopaths will address your expectations and advise you on how much change you can expect to see and over what timeframe so you can make the decision as to what is best for your child and your family.

Felicity Bertin is a registered Osteopath with post-graduate training in Cranial, Obstetric and Paediatric Osteopathy. She lectures in Embryology, Developmental Biology and Neuro-Musculo-Skeletal Medicine on the Masters in Osteopathy course at the British School of Osteopathy. She specialises in working with children with feeding difficulties and supports a team of lactation consultants and tongue-tie practitioners with “bodywork”, offering a biomechanical approach to breastfeeding difficulties. She has co-authored two books on children’s eating and works closely with a psychological therapist to give support to these families. She believes strongly that many early difficulties babies face can be helped with osteopathy that she has established a free assessment clinic and low-cost children’s clinic for babies under 6 months.

Should you wish to discuss any matters raised in this article or to make an appointment, she can be contacted at osteopathy@

© Felicity Bertin 2013

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