How to prevent flat head syndrome

Flat head syndrome is typically considered a cosmetic problem. It does not impact brain growth. That said, it’s important to take certain steps to ensure your baby’s skull doesn’t become flat.

What causes flat head syndrome?

At birth, babies’ skulls are soft and malleable. This is what makes it possible for the head to pass through the vagina during delivery. As a result, it’s not uncommon for a newborn’s head to be slightly misshapen. Things typically resolve themselves in the first few weeks after birth.

However, in some cases, the deformation may persist or worsen, or symptoms may arise in the first few months after the baby is born. Flattening of the skull usually starts to be apparent around 2 months of age.

From the time they are born, it’s important to vary the way you support your baby’s head, since the weight of a newborn’s head is relatively heavy compared to the rest of their body. Because their neck muscles are weak, their head may fall to one side or the other up to the age of 2 or 3 months.

The bone behind the ear or at the back of the head will gradually flatten if a baby’s head is always turned to the same side when they are sleeping or lying on their back. While it’s important to lay your baby on their back when sleeping to prevent sudden infant death syndrome, it’s best to vary their position while they’re awake.

A slight flattening of the head may self-correct if the baby is placed in different positions so that their head is not always resting on the same side. More significant flattening may not go away completely, but it won’t impact the brain’s development.

In most cases, flat head syndrome only occurs on one side of the head. But sometimes, the entire back of the head can become flat, creating the illusion that the back of the neck extends all the way to the top of the head.

The risk of developing flat head syndrome is greater when a baby stays in the same position for a long time. This can happen when the baby is often placed in a seat with a hard surface (a stroller, a car seat, the seat in the grocery cart, etc.). If they are left in their seat for too long in the same position, they can end up with a flattened skull.

How can you prevent your baby from developing a flat head?

• From the time they’re born, make sure your baby’s head isn’t always resting on the same side when you place them in their crib or on any other hard surface.
• As soon as they’re able to turn their head on their own, make sure it’s not always turned to the same side. You can do this by alternating the position in which you put them to bed: their head at the foot on the bed one night, the next day, the reverse. In addition, encourage them to look towards the rest of the room rather than the wall. A source of noise or a visual cue such as a mobile, your face, or a toy will attract their attention and encourage them to naturally turn their head to the other side.
• If you are bottle-feeding your baby, alternate the arm you use to support their head during feedings. This will ensure you’re not always supporting the same side of your baby’s head with your elbow.
• When your baby is awake, place them on their tummy as often and for as long as possible, every day. To help them get used to this position, lay down while facing them or put a toy in front of them. The Canadian Paediatric Society recommends that babies be placed on their stomach for 10 to 15 minutes at least three times every day. To learn how to get your baby used to this position, read our article on tummy time.
• Limit the amount of time your baby spends with their head resting on a hard surface, such as the floor or a swing. Their car seat should only be used when they are in the car.
• Encourage your baby to look in both directions by showing them a toy or a mirror, first on their right side, and then on their left. When babies are lying on their backs, they can turn their heads fully both ways.
• Have fun lying on your back tummy-to-tummy with your baby. Always steady them with your hands to prevent them from falling.
• Carry your child against you in a soft baby carrier, as this can decrease the risk of developing a flat head.

When should you consult a doctor?

It’s important to consult a doctor or pediatric physiotherapist if you notice that your baby:

• Seems to have a flat head
• Has limited neck movement, as this could be a sign of torticollis
• Has any delay in their motor development

You should also consult a doctor if you notice that the fontanelle on the top of your child’s head still bulges out when they’re sitting up, or if it’s still open after the age of 24 months.

Your health care provider may refer you to a pediatric osteopath or chiropractor. In general, the services offered by physiotherapists, osteopaths, and chiropractors are not covered by the Quebec Health Insurance Plan (RAMQ).

How do you correct a flat head?

If treated early enough, ideally before the age of 2 months, the condition improves in the vast majority of cases. A misshapen skull can also be the result of other causes, such as torticollis or the premature closure of a suture, that require other types of treatment.

Generally, regularly changing your baby’s sleeping position is enough to improve the shape of their skull within a few months. Physiotherapy exercises may also be recommended to help increase the neck’s range of motion.

In the rare case of severe deformity, a special helmet called a cranial remoulding orthosis is required to help the head regain its shape. These are most useful if the flat head has not improved by the age of 6 months despite repositioning and physiotherapy. They are much less effective after the age of 12 months.

Things to keep in mind

• Flat head syndrome usually starts to be apparent around 2 months of age.
• To prevent a flat skull, from the moment your baby is born, make sure their head isn’t always resting on or turned to the same side.
• If you notice that your baby has a flat head, schedule an appointment with your pediatrician or a physiotherapist who treats children from birth to age 5.

Scientific review: Nathalie Trottier, physiotherapy and osteopathy graduate and doctoral student in the health sciences research program at Université de Sherbrooke, and physiotherapists Nathalie Thiffault and Évelyne Labonté Research and copywriting:The Naître et grandir team Updated: October 2024

Photo: iStock.com/YoOura