The safest place for your baby to sleep is on their back.  The American Academy of Pediatrics (AAP) recommends “back to sleep for every sleep” for all infants up to 1 year of age to reduce the risk of Sudden Infant Death Syndrome (SIDS).  

There has been a rising incidence of flat head syndrome since the AAP began the “back to sleep” campaign in the early 1990’s.  

What Causes a Flat Head?

Babies have soft skulls, which allow their heads to pass easier through the birth canal.   These bones are also affected by pressure from laying on that area for periods of time.  Babies also have weak neck muscles making it more difficult to change their own positions.

Infants spend a lot of time sleeping, up to 17 hours per day.  That also means they are spending this much time on their backs.

Because of this, your baby’s skull might start to look flatter on the back or on the side your baby prefers to turn their head.  The medical term for flat head syndrome is positional plagiocephaly.

A flat head does not affect your baby’s brain development.  In many cases, the flat head goes away on its own.  

Are Some Babies At Higher Risk for a Flat Head?

Flat head syndrome is most commonly seen in the following:

• Boys
• Firstborns
• Premature infants
• Babies that sleep on their backs
• Insufficient “tummy time”
• Bottle feeding

Other important factors are preferred head position and limited head rotation.

The incidence of flat head syndrome varies.  One study found that 19.7% of infants at 4 months of age have some degree of positional plagiocephaly.  Another study from Calgary, Alberta quotes an incidence of 46.6% in infants 7-12 weeks of age.

What Can You Do To Prevent a Flat Head?

Not all of the risk factors for a flat head listed above are modifiable.  But there are some things you can do as parents to minimize development of a flat head.  

Tummy time when the baby is awake and supervised can help prevent a flat head.  It also has other benefits including strengthening the upper body of your baby to help with meeting milestones, like rolling over.  The Canadian Paediatric Society recommends 10-15 minutes of tummy time, three times per day.  

Another easy way to minimize development of a flat head is to alternate the baby’s position in their crib or bassinet every day.  The easiest way to do this is to put the baby’s head to the foot of the bed one day, and the head of the bed the next.  This encourages the baby to look away from the wall and sleep on both sides of their heads.  

Lastly, babies should not be placed in car seats or baby seats for prolonged periods of time.  

Treatment of Positional Plagiocephaly

The Congress of Neurological Surgeons have published guidelines on the management of positional plagiocephaly.  

Parents should be counseled about the preventative measures and the importance of following these recommendations.  This is especially important in the newborn period.  

Physiotherapy is a mainstay in the treatment of flat head syndrome.  A physiotherapist can provide mechanical adjustments and exercises for the parents to perform for neck mobility.  

Positioning pillows should not be used unless on the advice of a physician.  Pillows in the sleeping environment go against the recommendations for safe sleep. 

In more severe cases, some babies may require helmet therapy.  Helmets are worn for 23 hours per day.   Helmets can speed up the rate of improvement of the flat head, but do not seem to change the final outcome (when compared to repositioning therapy).  

If you have concerns about the shape of your baby’s head, talk to your doctor.  Earlier intervention is better. 

This post was co-authored by Erin Manchuk, BScPharm, BCGP and Stephanie Liu, MD, MSc, CCFP, BHSc.