Plagiocephaly aka Flat Head Syndrome: What You Need to Know

Thanks to carseats and strollers and perhaps a baby who hates tummy time, plagiocephaly, better known as flat head syndrome, happens. The good news is: it’s very fixable.

In this post, we’ll cover everything you need to know about the obscure-sounding condition, including:

  • What the heck plagiocephaly is
  • If infant helmets are really necessary
  • Plus, how to treat and prevent flat head syndrome naturally

What is Plagiocephaly?

Plagiocephaly is sometimes called positional plagiocephaly or deformational plagiocephaly, but you’re probably more familiar with this condition simply as “flat head syndrome.”

These terms all have one thing in common: They describe a baby’s head when it becomes flat and/or misshapen in certain areas.

Don’t panic, though! Before reading any further, please know that plagiocephaly is usually:

  • a benign condition
  • easy to treat
  • and does not need surgical correction

Is Plagiocephaly Common?

Flat head syndrome is increasingly more common.

According to the American Academy of Pediatrics, about 48 percent of babies have flat head syndrome.

Woah, what gives?! 

Why Is Flat Head Syndrome So Common?

In the not-too-distant past, mothers (and any caregivers really) used to wear babies more often. In fact, if you take a peak at rural civilizations or cultures less dependent on technology, it’s hard to find images of babies not being worn. Although babywearing is still popular today, it’s nowhere near as prevalent as it used to be, thanks to the arrival of strollers, swings, bouncy chairs, etc.

In addition to a change in culture, we’ve also seen a change in how babies sleep, thanks to the Back to Sleep Campaign to reduce instances of SIDs. (More on that below!)

What Causes Flat Head Syndrome in Babies?

According to the experts at Children’s Hospital Boston, the aforementioned things contribute to a rise in flat head syndrome, because baby is repeatedly laying in the same position. Because a baby’s skull is flexible (to allow for brain growth), the pressure from always laying on one side of the head can cause the skull to change shape. Let’s take a closer look at some of the most common causes of plagiocephaly:

Sleeping position

The increase in flat head syndrome coincides with the Back to Sleep Campaign of 1994, a movement created by the American Academy of Pediatrics, the National Institute of Child Health and Development, and the Maternal and Child Health Bureau to reduce SIDS. The campaign encouraged parents and caregivers to lay babies to sleep on their backs.

The campaign successfully reduced SIDS-related deaths by about 50 percent, but there was one unforeseen side effect: a ten-fold increase in flat head syndrome. (sourcesource)

Note: This is NOT a reason to change your baby’s sleeping position. 

Baby “containers”

Because laying in a baby swing, bouncy seat, or rocker for an extended period of time also puts pressure on baby’s malleable head, these containers also contribute to flat head syndrome.

As a side note, studies show that these containers are bad for baby’s development. (source) For instance, a swing limits baby’s movement to just “back and forth,” rather than the well-rounded movements of a mother moving around the house holding her baby. This can actually make it harder to soothe baby in the long-run.

Containers also reduce baby’s contact with another human, which can cause a dip in baby’s endorphins and happiness levels. Containers also delays the development of fine motor skills baby practices when playing on her tummy. What’s more? They don’t expose baby to as many things (dirt, germs, etc.) that stimulate and develop her immune system. (source, source, source)

Note: This doesn’t mean that if you use a swing, your baby won’t be happy, won’t form a good bond, or won’t develop fine motor skills; the key is to refrain from excessive swing use.

Premature birth

According to one study, plagiocephaly is more common in preemie babies, because their skulls are even more flexible. It’s interesting to note that researchers noticed a particularly strong correlation between premature birth and flat head syndrome in boys and twins.

Twins and multiples

In a multiple pregnancy, babies’ heads press against each other in utero, which can cause flat spots to develop where the two heads meet. (source

Is Plagiocephaly a Birth Defect?

Before we get to the bottom of this, it’s important to note that there are two types of plagiocephaly:

  1. Positional plagiocephaly
  2. Congenital plagiocephaly

Positional plagiocephaly—the most common type of flat head syndrome—is not a birth defect. It is caused by the lifestyle factors discussed above.

On the other hand, congential plagiocephaly, or craniosynostosis, is a genetic condition that is considered a birth defect. When this happens, the skull’s shape is affected not by position, but by an early fusing of baby’s skull, which forces the skull to morph as the brain grows. This is a serious, but very rare condition that neuroseurgons can successfully correct with surgery. (source)

How to Tell If Baby Has Plagiocephaly

Curious if your child has flat head syndrome? Here are a few signs that might tip you off:

  1. Flat spots (can be on the sides or on the back of the head)
  2. Asymmetric areas
  3. Less hair in certain spots, particularly the back of the head

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This little lady has officially graduated from physically therapy and check ups at Shriners hospital 👏🏼👏🏼👏🏼 . Around the time Mia was 2 months I started to notice a flatness on the right side of her head. So naturally I googled the shit out of it and went into mom guilt and anxiety mode. 😳 . At her next doctors appointment I mentioned it and they put in a consult with Shriners. There they took measurements of her head and diagnosed her with plagiocephaly and torticollis. Aka a flat head and stiff neck. 😢 . I constantly found myself… blaming myself. Did I not do enough tummy time? Did I let her lay in her rock and play too long? Why didn’t I notice her head always going to the same side? 💔 . Then, the discussion of helmets came up. Again, anxiety mode. My daughter is adorable and would have looked super cute in one, but it was the fear of the unknown. Will she hate it? How do I clean it? How will we pay for it? Because it was most likely not covered by insurance because it’s listed as a “cosmetic”. Insurance treating it like it was plastic surgery for her 🙄. . We decided to start physical therapy right away. We went once a week to Shriners. Then, every other week. Eventually we were enrolled in Early Intervention where therapy came to us. . Each appointment her neck got stronger and stronger and we started to notice a difference in her flat spot. . Now, here we are 8 months of therapy, hard work and no helmet 👏🏼👏🏼👏🏼 I am so grateful to have had Shriners in our home town for Mia to receive the help she needed. They were always so kind and helpful with all of our questions and needs. 💕 . Congratulations baby girl, you worked hard and proved how tough you are 😘 . #plagiocephaly #torticollis #momguilt #whitnessthelegacy

A post shared by Lauren Whitman (@fitwhit24) on

This baby was diagnosed with flat head syndrome (left image). Here is the same baby eight months later (right image) after physical therapy. 

Even thought symptoms may be obvious and the pictures may be helpful, you still need to see your pediatrician to make an official diagnosis and rule out congenital plagiocephaly. 

I know this sounds super scary, but try not to worry! Most pediatricians check for flat head syndrome during routine checkups, and it’s important to remember that the condition generally resolves on its own.

Why Do Babies Wear Helmets?

When it comes to flat head syndrome, your doctor might be quick to recommend a cranial helmet. These are special helmets are designed to encourage your baby’s skull to take the proper shape. Some of these helmets are darling, by the way!

But do the helmets even work?

According to an article published in The Journal of Craniofacial Surgery, laser scans of babies’ skulls four months after treatment show helmet therapy does help. But—and this is a big but—to get the most out of helmet therapy, researchers say babies must wear the helmets for up to 23 hours per day!

Besides this research, there are very few reputable studies that suggest these expensive helmets make great improvements. (source, source) In fact, in one study, 25 percent of babies made a full recovery with helmet treatment and 22 percent of babies made a full recovery without helmet treatment. The conclusion of the study?

Statistically speaking, there isn’t enough evidence to suggest helmets are worth the time, effort, and expense. (source)

Even the AAP states, “Helmet therapy is rarely necessary.”

What About Plagiocephaly Pillows?

In an attempt to reduce pressure on baby’s skull, many parents have considered using plagiocephaly pillows (like this one), but this isn’t an ideal solution either. These pillows, which are soft pillows with a hole in the center, are designed to reduce the pressure on the back of baby’s head. While this idea is good in theory, plagiocephaly pillows are not recommended, because soft pillows can be a SIDs risk. (source)

How to Fix Flat Head Syndrome

So with helmets having questionable benefits and plagiocephaly pillows definitely off the table, what can you do for flat head syndrome?

Try these lifestyle changes:

    • Prioritize tummy time: During tummy time, baby’s head is elevated, which takes the pressure off of his/her skull. Tummy time also gives baby ample opportunity to strengthen their neck muscles. The best part? Tummy time is safe for babies of all ages—even newborns! Read more about how to do tummy time here.
  • Reposition baby’s head from side to side as they sleep: Some parents also encourage repositioning by alternating which direction they lay baby during diaper changes. Because baby will naturally turn his head to look at you, this will prevent baby from always laying on one side during naps and diaper changes. If you co-sleep and nurse through the night, you can change which side you lay on to encourage baby to sleep on the other side as well.
  • Limit time in containers, swings, etc.: Not only will limited time in the swings prevent flat head syndrome, limited container time can also foster better motor skill development. When babies get ample tummy time and play on the floor, they are working on the very skills they need to help them crawl!
  • Babywear as often as possible: This is a great option if you’re trying to cut back on time spent in strollers and swings. New to babywearing? Check out the Mama Natural guide to babywearing here.

How Long Does Plagiocephaly Take to Correct Itself?

Once you start implementing a few of these practices, you may start to notice changes in about six to eight weeks. (source) Of course, the time frame varies based on how many of the lifestyle changes you adopt and how severe baby’s case is. Instead of choosing just one practice (like babywearing), try incorporating as many of them as possible!

How to Prevent Plagiocephaly

The good thing about plagiocephaly is that you can do a lot of things to prevent it from developing in the first place, and these methods are similar to the methods used to correct it. The most important thing is to keep pressure off baby’s skull. When baby is awake, do tummy time, babywear, and keep baby busy and off his/her back. It’s not just good for the shape of baby’s head; it’s good for his or her development in general!

How About You?

Was your baby diagnosed with plagiocephaly? How did you treat it? Did you implement natural methods?

About the Author

Genevieve Howland is a childbirth educator and breastfeeding advocate. She is the bestselling author of The Mama Natural Week-by-Week Guide to Pregnancy and Childbirth and creator of the Mama Natural Birth Course. A mother of three, graduate of the University of Colorado, and YouTuber with over 75,000,000 views, she helps mothers and moms-to-be lead healthier and more natural lives.

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