HealthInfo Canterbury

Flat head in babies (plagiocephaly)

Upoko papatahi ki ngā pēpi

A flattened area of a baby's head (usually at the back and to one side) is called plagiocephaly.

A tamaiti (child) with plagiocephaly may:

• have less hair on the flattened area due to rubbing on the bed or floor
• prefer to rest their head on this area
• have one ear further forward than the other
• have a flattened area on their forehead, opposite the flattened area at the back.

Causes of flat head in babies

Babies' skulls are soft and can be moulded into a flat shape. This is caused by pressure and gravity if the baby's head stays in one position for a long time. It's most likely when the babies are young and have less head control.

There may be no obvious cause, but possible causes of flattened areas are:

• sleeping on their back without varying their head position
• having too little tummy time when they're awake (tummy time is when they're placed on their tummy)
• spending a lot of time in car seats, bouncinettes and prams, especially if the pēpi (baby) sleeps in this equipment
• lying in one position in the womb for a long time. This is most likely if they're cramped for space, especially with twins, triplets and so on.

Flattened areas are often associated with a twisted neck (torticollis). Torticollis is when the pēpi cannot move their head much in one direction and prefers to turn it to one side. Flattened areas and torticollis can also happen independently.

A rare cause of flat head in pēpi is a problem with the bones in the skull being fixed together too soon (craniosynostosis). If you're concerned your pēpi has an unusually shaped head, get them checked by your general practice team.

Treating flat head in babies

These recommendations can treat flattened areas on a baby's head as well as prevent them.

Sleeping

• To reduce the risk of sudden unexpected death in infancy (SUDI), always put your pēpi to sleep on their back and keep their face clear. Also see Safe sleeping for babies.
• When your pēpi is asleep, turn their head to one side and alternate sides for each sleep time. If a flattened area has developed, turn their head away from the flattened area and onto the more rounded side every sleep time.
• Encourage your pēpi to turn their head both ways while lying in their cot. Your pēpi may turn their head towards points of interest (such as doorways, windows or toys). If this happens, you may need to change the end of the cot the pēpi sleeps at or turn the cot around.

Floor time

• Always supervise your pēpi when they're having floor time.
• When your pēpi is awake, place them on their back with a rolled-up towel under their preferred side. Put their toys on their non-preferred side. This will help to keep the pressure off the flattened area.
• Sit or lie on the floor next to your pēpi alternating the side you're on or staying on their non-preferred side if they have one.
• When your pēpi is lying on the floor, place them in the room so they're looking towards the light or where the action is.
• Place your pēpi on their side with a rolled-up towel behind them to keep them in position. This helps to keep their neck in a neutral position and keeps the weight off the back of their head.

Tummy time

• Place your pēpi on a firm surface allowing free breathing.
• You can do tummy time in a variety of ways. For example, on a parent's chest, over a wedge, over a cushion, over a rolled-up towel or over an adult's legs.
• Put toys on both sides of their face to encourage them to turn their head (or just on the opposite side to the flattened area if there is one).
• Interact with your pēpi from both sides (or just on the opposite side to the flattened area if there is one).
• Your pēpi may not tolerate long times on their tummy to start with. Build up the time with short, frequent periods of practice throughout the day. For example, after each nappy change.
• Start with just a minute or two and gradually increase to as much time as your pēpi can manage.
• Take breaks when your pēpi shows signs of tiredness. For example, grizzling, grunting and so on, but before they start crying.
• Aim for at least 30 minutes a day. This can be over several short periods throughout the day.

Other

• Limit the time in car seats, prams, strollers and so on. Take your pēpi out of the equipment when it isn't needed.
• Don't use Jolly Jumpers and ExerSaucers as positioning devices, especially for young pēpi. Time on the floor is much more important for developing movement skills and strength.

Contact your general practice team or Well Child Tamariki Ora provider if you've tried the above advice and your baby's head isn't getting better or if you have any questions.

  HealthInfo recommends the following pages

• KidsHealth – Positional head-flattening in babies

  How to prevent your pēpi baby getting a flat head, and what to do if they develop one.

Written by HealthInfo clinical advisers. Last reviewed August 2022.

Sources

Page reference: 114677

Review key: HIFHC-114677