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Positional Plagiocephaly: Flat Head Syndrome

What is positional plagiocephaly?

Positional plagiocephaly (play-gee-oh-SEF-uh-lee), also called flat head syndrome or deformational plagiocephaly, is a flattened area on the back of a baby’s head. It is usually caused by lying in the same position too often and for too long. In some cases, the baby’s forehead and face may also be affected. A baby’s skull grows very rapidly, so the flattened area can develop in mere months.

Causes of positional plagiocephaly

In most cases, plagiocephaly happens when a baby sleeps in the same position too consistently. The baby may prefer to sleep on a particular side.

A small number of babies are born with a flat head. Called congenital plagiocephaly, this can happen in multiple births or because of the baby’s position in the womb. Babies’ heads are very soft at birth to help them get through the birth canal. Because of this, it’s not unusual for a baby to have a pointy or misshaped head at birth. This usually goes away in about six weeks.

Some babies have very tight muscles on one side of the neck that make it hard for them to turn their heads. Because this condition, called torticollis (tor-tuh-KAA-luhs), can cause babies to keep their heads in the same position, it can be an underlying cause of positional plagiocephaly.

Plagiocephaly or craniosynostosis?

Positional plagiocephaly can look a lot like a different, more serious condition called lambdoid craniosynostosis (CRA-nee-oh-sin-us-TOE-sis). It’s important to find out which one is causing the flat head. Lambdoid craniosynostosis is caused when the bones in a baby’s head grow together too soon in the baby’s development. This condition is very rare, but it requires surgery.

Plagiocephaly is very common and does not require surgery for treatment. A craniofacial specialist can determine which condition a baby has, usually with just a physical examination.

How positional plagiocephaly is diagnosed

Your pediatrician will do a physical examination of your baby's head as part of routine checkups. If the doctor diagnoses positional plagiocephaly, you will most likely be given instructions on how often and when to change your baby’s position. In some cases, this will be enough for your baby’s head to change to a normal shape over time.

If your baby’s head shape doesn’t improve, your pediatrician may refer you to a pediatric craniofacial specialist. At Children's of Mississippi, our craniofacial team includes pediatric plastic surgeons and nurse practitioners with specialized training in treating children with head and facial differences.

A craniofacial specialist on our team will meet with you and examine your baby, taking two measurements diagonally across the top of your baby’s head. He or she will compare the measurements to see how much the flattening is affecting the shape.

Positional plagiocephaly can be considered mild, moderate or severe, depending on the difference between the two diagonal measurements. A difference of 0-5 millimeters is mild; 5-10 millimeters is moderate; 10 millimeters or more is severe.

Treatments for positional plagiocephaly

Fortunately, surgery isn’t required to treat positional plagiocephaly. In many cases, doing things to change the baby’s head position will be enough for it to get better on its own over time. For most children, positional plagiocephaly will not limit brain growth or cognitive development.

Some things your doctor may recommend include:

• Alternate the direction of your baby’s head in the crib. One night, put the baby’s head at the head of the crib; the next night, place it at the foot of the crib.
• Give your baby plenty of “tummy time.” Place your baby on his/her tummy while they are awake and you are watching. Try for at least three times a day for 10 to 15 minutes each time. This helps strengthen neck, shoulder and arm muscles, and helps your baby hit important developmental milestones.
• Cuddle your baby, holding him/her upright with the head over your shoulder.
• When your baby is awake, don’t leave him/her for long periods of time in car seats, carriers or bouncers.
• Be careful not to put a lot of pressure on the flattened part of your baby’s head when you are holding him/her, including feeding time. It’s better to change your baby’s head from side to side when nursing.
• If possible, move your baby’s crib to different places in the room. This will encourage your baby to look in a different direction to see the door, the window or a light.

If your baby has torticollis, a pediatric physical therapist will need to work on the stiff muscles of the neck so your baby’s head can turn easily.

In more severe cases, your baby may need to wear a specially fitted helmet that will mold the head as it grows. How long your baby will need to wear the helmet will depend on several factors. Because your baby’s head is growing very quickly, the helmet will need to be adjusted on a routine basis. The team will also make sure the helmet isn’t irritating the skin underneath or causing an allergic reaction.

Without treatment, if the face is affected and doesn’t grow into a normal shape, a child might have problems with chewing, eating and vision. Older children might feel self-conscious about their appearance.

The kind of treatment that will be recommended for a baby depends on the severity of the condition and the baby’s age.

General guidelines for recommended treatment include:

Age	Treatments
Before 4 months	Positioning changes Physical therapy for torticollis
4–6 months	For mild to moderate severity, continue positioning changes For severe conditions, begin helmet therapy if head control is developed
Older than 6 months	For mild to moderate cases that have not improved with positioning changes, begin helmet therapy For severe cases, begin helmet therapy

How to prevent flat head in babies

Fortunately, the same strategies that may treat positional plagiocephaly also help to prevent it. These include having sufficient tummy time, alternating sleeping positions and/or crib position in the baby’s room, avoiding too much time in car carriers and bouncers, cuddling over your shoulder and changing positions during feedings.

Get help at Children’s of Mississippi

If you are concerned about a flat spot on your baby’s head, you can request an appointment with a craniofacial specialist at Children’s of Mississippi. Request an appointment online.

Last reviewed: July 14, 2025