How Do I Prevent My Baby From Developing a Flat Head?

By Karen Pohl

April 24, 2020

You’ve had your baby. You’ve read all the things. You’re trying to follow all the recommendations to keep your baby safe including placing them on their back to sleep every time they sleep. But you notice there’s a flat spot starting to develop at the back of their head. Or maybe you had a baby who had a rough start and they spent some time in the NICU getting strong before they could come home with you and you notice your baby’s head is just not quite round. Now what?!

First, don’t stress! It’s actually pretty common for babies to get flat spots early on as their head shape changes and rounds out. There are some things that can make a baby more susceptible to developing these spots and a few things we can all do to prevent them.

Plagiocephaly is the fancy term for flat head syndrome. Some babies are born with flat spots just from the way they were wedged in their mama’s belly, and multiples are at higher risk of being born with plagiocephaly simply because they’re sharing tight quarters with another baby (or more!).

Other babies develop positional plagiocephaly during the first few months of life. This can be caused by a few different things like sleeping on their backs, spending a lot of time in “containers” or as a result of torticollis. Torticollis is when the neck muscles (usually just on one side) are stiff or tight and restrict the baby so they do not have a full range of motion of their neck. Babies with torticollis are at higher risk of developing a flat spot simply because when they are on their backs they are unable to turn their head from side to side so they typically stay in the same position every time they sleep.

Left: My niece Evelyn at just a couple of weeks old. She was born with torticollis and you can see her head tilt towards her right shoulder. Right: Here is Evelyn again at 9 months old. She went to physiotherapy and an infant chiropractor to treat her torticollis which is fully resolved in this picture. You can see she is able to hold her head nice and straight

If you notice that your baby was born with a flat spot, developing a flat spot in their first few months or tilts their head to one side a lot, let your doctor know and ask for a physiotherapy referral. Here in Ontario, PT services are covered by OHIP for infants and some will even come to your house. If you are looking for a PT privately, make sure they are a pediatric PT and have experience with babies with torticollis and/or plagiocephaly.

Things you can do to prevent flat spots from developing are:

  • Tummy time is so important for helping develop your baby’s neck, shoulder, and core muscles. Right from the beginning, start working on short periods of tummy time a few times a day. Only practice tummy time when awake and supervised. There are lots of ways to practice! You don’t have to put your baby flat on their belly on the floor. Many babies will hate that especially at first! Tummy time can be done as easily as you sitting slightly reclined with your baby lying on your chest facing you. Some babies need to work up to being flat on their tummy so from here you can lay down further until you’re flat on your back with baby lying on your belly. Another trick that helps is rolling a towel up tightly and placing it in on the floor under the baby’s underarms/chest to prop baby up. Work towards getting them down on the floor for tummy time. Tummy time is where so many motor skills are practiced and core strength is developed.
  • When in the stroller or car seat, center baby’s head and body. It’s very important NOT to use any infant inserts that did NOT come in the box with your infant car seat. However, if your baby needs some extra support to keep them centered in their car seat, it is safe to strap them in as you normally would, make sure their straps are snug, and pass the pinch test. Then straighten them as much as you can, and you can then use a receiving blanket or small towel rolled tightly and put one on either side of the baby. You would place this right along their body from their ear right down to their bum. This does not interfere with the car seat straps or function and is what Certified Child Passenger Safety Technicians (CPST) recommend doing for babies who need a little more support. Click here for how to do this safely.
  • Back to sleep – always place baby on their back to sleep. Turn their head the opposite way each time you lay them down. Another good trick is to flip the “head” of their bed each day. Babies tend to turn towards noise so if their head is always at the same end of their bed and they are hearing noise come from the same direction, they’ll keep turning that way each night. Flipping that daily can help encourage them to turn the other way.
  • Encourage your baby to look both ways. One way you can do this is when feeding, alternate which arm you hold them in. This is easier to do when breastfeeding as you will often switch sides. But babies who are bottle-fed are more often held in the same arm, in the same position for most feeds.
  • Limit time in “containers”. The term “containers” refers to any baby products that hold the baby and prevent them from moving freely. So baby swings, car seats, bouncy seats, rockers, rock n plays, etc. We can’t avoid all of these things all of the time, especially car seats as they are essential to safely transporting your baby in the car. But being mindful of how often and how long baby is in these “containers” and trying to limit that time is important. Infant car seats are easy to transport and it’s really easy to leave the baby in their car seat outside of the car, especially if they’re sleeping. Always take the baby out of their car seat when it is not in the car. If you’ve arrived at your destination, and baby is asleep, just take them out and lay them in a safe space like a pack n play or crib to continue their nap.

What if my baby’s head shape gets worse or doesn’t improve?
Some babies need help rounding out their heads. Physiotherapy, repositioning and the tips mentioned above don’t always prevent a flat head or isn’t always enough to help round out their head. That’s ok. There are cranial remolding helmets. You may have seen them on social media in the past couple of years as a couple of celebrities have had babies with cranial remodeling helmets. There are various brands in Canada and the United States but they all essentially do the same thing. They are made specifically for each individual baby and it prevents the head from continuing to grow in the “wrong” direction and allow the flat parts to round out. Cranial remodeling treatment can start as early as 3 months of age (depending on the brand of helmet) up until the fontanels (soft spots) close – most clinics will stop treating babies around 12-18 months of age. Once the soft spots are closed, the helmets are rarely effective since head growth slows down significantly and the bones of the skull fuse at that point. When the fontanels are still open they are able to shift, and as the head grows, the helmet helps control the shape the head grows into. Most babies who require helmets will wear their helmet for at least 6 weeks up to many months. Length of treatment is dependent on each individual baby, how severe their head shape is, how old they are when they start treatment, and how quickly their head grows.

This is my son Benjamin at 5 months old wearing his Snugkap. Click here to learn more.

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