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Flat Head Syndrome & Your Baby: Information about Positional Skull Deformities

​​​​​Did you know 1 in 3 of all babies will show some type of positional skull deformity?

Positional skull deformities, often referred to as "flat head syndrome," are changes to the shape of a baby's head related to spending more time in one position than in others. The risk is greatest during the first four months of life and generally shows improvement by 6 months of age as babies become more mobile and turn their heads on a regular basis on their own.

3 Common Head Shapes Associated with a Positional Skull Deformity

  • Brachycephaly—Head is symmetrically flat in the back and wide from side to side.  There may be prominence of the bone above the ears. This is often seen in babies who spend a lot of time on their backs and do not get enough tummy time.
  • Posterior plagiocephaly—Asymmetric head that is flat in the back on one side.  The forehead may be more prominent causing the head to look like a parallelogram. The ear may also shift forward on the flat side. This is often seen in babies who also have torticollis.
  • Scaphocephaly—Head is narrow and long. This is most common in preemies who have spent their first few months of life in the neonatal intensive care unit (NICU).

What Causes a Baby's Head to Become Flat?

A baby's skull is soft, with mobile bones. This allows the head to pass through the birth canal at the time of delivery and gives the brain room to grow rapidly during the first year of life. 

There are many reasons why a baby's head becomes flat. Some of the most common risk factors associated with positional skull deformities include:

  • Twins or triplets— When multiples are cramped or in unusual positions in their mother's womb, their head shape can change.
  • Prematurity—Sometimes, the prolonged periods of lying flat on his or her back in the hospital can cause a baby's head to become misshapen. The bones of preemies are also softer than and not as fully-formed as the bones of full-term babies.  
  • Birth complications—Strains on the head can occur at birth based on the way the baby was positioned as he or she moved through the birth canal. External force such as from forceps, vacuum extraction, or even a difficult labor can also impact head shape.
  • Preferred head position—Unfortunately, some babies show a preference for sleeping or sitting with their heads turned in one direction most of the time. When the head is constantly turned to one side or stays in the center, the consistent pressure molds a flat spot into the skull.
  • Limited exposure to tummy time—Lack of tummy time can not only affect head shape, but also how long it takes for a baby to master basic milestones such as head lifting, turning over, sitting up, and crawling.
  • Torticollis—An estimated 85% of babies with torticollis, a condition where the neck muscles are tight or imbalanced, have a positional skull deformity.  

It is important to note that positional skull deformities are purely cosmetic. They do not change the volume or contents of the head, nor cause problems with brain growth or intellectual development.

Early Detection of Flat Head Syndrome

After bath time when a baby's hair is wet, parents and caregivers can easily check for:

  • Symmetrical roundness in the back of the head
  • Evenness of the ears
  • Symmetrical width of the head
  • Symmetrical width of the forehead

If asymmetries or unevenness is seen, talk to your pediatrician. Most changes to the shape of the head are related to position and are not dangerous. However, your pediatrician will need to differentiate between a positional skull deformity and craniosynostosis, an uncommon, but more serious cause of infant head shape change.


The best treatment for a flat head is to prevent it from happening. It is important to establish these habits early! When flattening is noticed early, the same techniques used for prevention can help nip it in the bud.

  • When possible, avoid pressure on the back of the head, such as prolonged time in a car seat, bouncy seat, baby swing, or other carriers.
  • Increase "tummy time," which is supervised time during the day when your baby lies on his or her stomach.  Start with small spurts of time and gradually work up to an hour per day in several shorter increments. Tummy time also lets your baby exercise their neck, back, shoulders, arms and hips.
  • Put your baby to sleep on a firm, flat surface (on his or her back).
  • Alternate arms when holding and feeding your baby.
  • Alternate your baby's head position by frequently placing him or her down for sleep at opposite ends of the crib.
  • See Back to Sleep, Tummy to Play for other things you can do.

Early Intervention & Therapy

Your pediatrician may refer your baby for early intervention services and an evaluation from a pediatric physical therapist specializing in the assessment and treatment of infants. The therapist will check your baby for delayed motor skills caused by poor head and neck control and teach you stretching and positioning exercises to do with your baby at home.

Depending on the severity of your baby's condition, weekly therapy may be recommended. In addition, some babies will need to wear a helmet to re-shape their heads. See Baby Helmet Therapy: Parent FAQs.

Surgery should only be considered when all other options have been exhausted, and after consulting with a pediatric plastic surgeon who specializes in these types of cases.

Additional Information:

Last Updated
Section on Plastic Surgery (Copyright © 2016 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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