Baby Head Shape: Understanding Flat Spots and When to Worry

Noticing an uneven or flat spot on your baby’s head can be alarming for new parents. However, irregular head shapes in infants are surprisingly common and often resolve naturally. Understanding why babies develop flat spots, how to prevent them, and when medical intervention is necessary can help you feel more confident about your infant’s development.

Why Do Babies Have Soft, Malleable Skulls?

Unlike adult skulls, which consist of fused bony plates, an infant’s skull is made up of several soft, flexible bone plates separated by fibrous joints called sutures. This unique structure serves two essential purposes:

• Facilitating birth: The flexibility allows the baby’s head to compress and mold as it passes through the birth canal during delivery
• Accommodating rapid brain growth: During the first year of life, a baby’s brain typically triples in size, and the flexible skull provides the necessary room for this dramatic growth

While this malleability is vital for healthy development, it also means that external pressure can temporarily shape the skull, leading to flat spots or asymmetrical head shapes.

Common Causes of Uneven Baby Head Shape

Several factors can contribute to an irregular head shape in newborns and young infants:

Prenatal Positioning

Before birth, babies spend months in the confined space of the womb. Certain prenatal conditions can affect head shape:

• Multiple pregnancies (twins or triplets) with limited space
• Breech positioning or other unusual fetal positions
• First pregnancies where uterine muscles are tighter
• Low amniotic fluid levels

Head shape irregularities caused by womb positioning are completely beyond parental control and typically improve within the first few weeks after birth.

Birth Process

The journey through the birth canal can temporarily reshape a baby’s head:

• Prolonged or difficult labor
• Use of delivery assistance tools such as forceps or vacuum extraction
• Fast deliveries with significant pressure on the head

Birth-related head molding usually corrects itself within six weeks as the skull bones shift back to their natural position.

Positional Plagiocephaly

The most common cause of uneven head shape develops after birth through repeated pressure on one area of the skull. This condition, known as positional plagiocephaly or deformational plagiocephaly, occurs when babies consistently rest in the same position.

Risk factors for positional plagiocephaly include:

• Spending excessive time lying on their backs in cribs, car seats, bouncers, or swings
• Premature birth, which means more time with a softer skull
• Neck muscle tightness (torticollis) that limits head movement
• Developmental delays that reduce the ability to change positions independently
• Being a firstborn child (parents may be less experienced with repositioning)

Brachycephaly

This condition occurs when the entire back of the head becomes flattened, making the skull appear wider and shorter than typical. Brachycephaly also usually results from positional pressure rather than any structural abnormality.

Craniosynostosis

In rare cases, an abnormal head shape results from craniosynostosis, a condition where one or more skull sutures fuse prematurely. This prevents normal skull growth and can cause:

• An abnormally shaped head that worsens over time
• A hard ridge along the affected suture
• Slow or no growth of the head
• Increased pressure inside the skull

Craniosynostosis requires medical evaluation and often surgical treatment to allow proper brain development.

Types of Baby Head Shape Abnormalities

Healthcare professionals classify head shape irregularities based on their appearance and location:

Plagiocephaly

Characterized by flattening on one side of the back of the head, creating an asymmetrical appearance. The head may look like a parallelogram when viewed from above, with the ear on the flattened side possibly pushed forward.

Brachycephaly

Involves flattening across the entire back of the head, resulting in a wider, shorter skull shape. The head appears disproportionately wide when viewed from the front or back.

Scaphocephaly

A long, narrow head shape that is typically associated with premature fusion of the sagittal suture (the suture running from front to back along the top of the skull).

Trigonocephaly

A triangular-shaped forehead caused by premature fusion of the metopic suture (the suture running down the middle of the forehead).

Should You Be Concerned About Your Baby’s Head Shape?

Most cases of uneven head shape are purely cosmetic and do not affect brain development, cognitive function, or overall health. Positional flat spots rarely cause developmental problems and often improve significantly as babies become more mobile.

However, you should consult your pediatrician if you notice:

• Severe or worsening asymmetry after 3 months of age
• A hard ridge along your baby’s skull
• Restricted head or neck movement
• Your baby consistently turns their head to only one side
• Uneven facial features or ear positioning
• Delays in reaching developmental milestones
• The soft spot (fontanelle) closes earlier than expected

How Doctors Assess Baby Head Shape

During routine well-baby visits, pediatricians regularly monitor head shape and growth. The evaluation typically includes:

Visual Inspection

The healthcare provider examines the head from multiple angles, looking for asymmetry, flat spots, or unusual contours.

Head Circumference Measurement

Measuring the head circumference at each visit helps track whether head growth is following normal patterns. Measurements are plotted on growth charts specific to the baby’s age and sex.

Palpation

The doctor feels the skull sutures and fontanelles (soft spots) to ensure they remain open and appropriately flexible.

Neck Assessment

Checking for torticollis or limited neck mobility helps identify underlying causes of positional preference.

Imaging Studies

If craniosynostosis is suspected, the doctor may order:

• X-rays to visualize the skull bones and sutures
• CT scans for detailed three-dimensional images
• Ultrasound in young infants as a radiation-free alternative

Prevention Strategies for Flat Spots

While you cannot prevent head shape irregularities caused by birth or prenatal positioning, you can take steps to minimize the risk of positional plagiocephaly:

Practice Safe Sleep with Variety

Always place your baby on their back to sleep, as recommended to reduce the risk of Sudden Infant Death Syndrome (SIDS). However, you can vary your baby’s head position:

• Alternate which end of the crib your baby’s head faces
• Position the crib so interesting objects (windows, mobiles) encourage your baby to turn their head in different directions
• Gently turn your baby’s head to alternate sides when they fall asleep

Prioritize Supervised Tummy Time

Tummy time is crucial for preventing flat spots while also strengthening neck, shoulder, and arm muscles. Start with short sessions several times daily:

• Begin with 3-5 minutes, 2-3 times per day in the newborn period
• Gradually increase duration as your baby grows stronger
• Make tummy time engaging with toys, mirrors, or your face at baby’s eye level
• Try tummy time during diaper changes or after naps when babies are alert
• Place your baby tummy-down on your chest for bonding and muscle development

Minimize Time in Containers

While car seats, bouncers, and swings are convenient, prolonged use can increase pressure on the back of the head:

• Remove your baby from car seats once you arrive at your destination
• Limit time in bouncers, swings, and seats to 15-30 minute intervals
• Prioritize floor time on play mats
• Use baby carriers or wraps that keep your baby upright against your body

Vary Holding and Feeding Positions

Change how you hold and feed your baby to distribute pressure evenly:

• Switch arms when bottle feeding or supporting your baby
• Alternate breasts if breastfeeding
• Hold your baby upright for burping and cuddles
• Carry your baby in different positions throughout the day

Encourage Active Movement

As your baby develops, promote activities that reduce stationary positioning:

• Allow plenty of supervised playtime on the floor
• Encourage rolling, reaching, and exploring
• Support sitting practice once your baby shows readiness

Treatment Options for Uneven Head Shape

Treatment approaches depend on the underlying cause and severity of the head shape abnormality.

Repositioning Therapy

For mild to moderate positional plagiocephaly or brachycephaly, repositioning techniques are the first-line treatment. Your pediatrician will provide specific guidance tailored to your baby’s needs, which may include:

• Continuing safe sleep practices while alternating head position
• Increasing supervised tummy time
• Reducing time in positioning devices
• Varying feeding and holding positions

Repositioning therapy works best when started early, ideally before 4 months of age, when the skull is most malleable.

Physical Therapy

If your baby has torticollis or shows a strong preference for turning their head to one side, physical therapy can help. A pediatric physical therapist will:

• Assess neck muscle strength and range of motion
• Teach you gentle stretching exercises
• Demonstrate positioning techniques to encourage head turning
• Provide activities that promote balanced muscle development

Most babies show significant improvement within a few months of consistent physical therapy exercises.

Helmet Therapy (Cranial Orthosis)

For moderate to severe positional plagiocephaly that does not improve with repositioning, helmet therapy may be recommended. A custom-fitted helmet or band gently redirects head growth into a more symmetrical shape.

Key points about helmet therapy:

• Most effective between 4 and 6 months of age
• Can still provide benefits up to 18 months, though treatment takes longer
• Requires wearing the helmet 23 hours per day
• Treatment duration typically ranges from 2 to 6 months
• Requires regular adjustments as the skull grows
• The helmet has open areas allowing growth in flattened regions while gently restricting growth in prominent areas

Not all babies need helmet therapy, and research shows that many cases of positional plagiocephaly improve significantly without helmets as babies become more active.

Surgical Treatment

Surgery is reserved for craniosynostosis, where prematurely fused skull sutures restrict brain growth. Surgical options include:

• Endoscopic strip craniectomy: A minimally invasive procedure typically performed before 6 months of age, followed by helmet therapy
• Cranial vault remodeling: A more extensive procedure that reshapes the skull, usually performed between 6 and 12 months of age

The specific surgical approach depends on which suture is affected, your baby’s age, and the severity of the condition. Following surgery, careful monitoring ensures proper healing and continued development.

How to Check Your Baby’s Head Shape at Home

While healthcare providers monitor head shape at regular checkups, parents can also observe their baby’s head between visits.

To assess your baby’s head shape:

1. View from above: Gently look down at the top of your baby’s head. It should appear evenly oval, like an egg shape, without flat areas or bulges
2. Check ear alignment: Look at your baby’s head from the front and back. The ears should be at the same height and distance from the center of the head
3. Observe facial symmetry: The forehead, cheekbones, and facial features should be balanced, without one side appearing more prominent
4. Feel for ridges: Gently run your fingers over the skull. You should not feel hard ridges along the suture lines
5. Monitor the soft spots: The fontanelles should feel soft and slightly concave, not bulging or sunken

Take photos periodically from the same angles. This helps you track changes over time and provides useful information for your pediatrician if concerns arise.

Long-Term Outlook for Babies with Flat Spots

The prognosis for positional plagiocephaly and brachycephaly is excellent. Most cases improve significantly as babies:

• Spend more time upright as they learn to sit
• Develop stronger neck muscles
• Become more mobile, reducing time in one position
• Grow hair that conceals minor residual flattening

Studies show that positional head shape abnormalities do not cause:

• Developmental delays
• Cognitive impairment
• Learning disabilities
• Behavioral problems

Even without treatment, research indicates that most positional flat spots become barely noticeable by school age. Any minor asymmetry that persists is typically cosmetic only and hidden by hair.

For babies treated for craniosynostosis, outcomes depend on timely intervention. When treated early with surgery, most children achieve normal brain development and satisfactory cosmetic results.

When to Seek Medical Advice

Contact your pediatrician if you notice:

• A flat spot that appears suddenly or worsens rapidly
• No improvement in head shape despite consistent repositioning efforts
• Inability to turn the head to one side
• Bulging or depression of the soft spots
• A ridge you can feel along the skull
• Unusual head shape at birth that doesn’t improve within 6 weeks
• Head circumference growing too quickly or too slowly
• Vision problems or unusual eye movements
• Developmental concerns

Trust your instincts as a parent. If something seems wrong with your baby’s head shape or development, seek professional guidance. Early intervention, when necessary, typically yields the best results.

Common Questions About Baby Head Shape

Can I use special pillows to prevent flat spots?

The American Academy of Pediatrics advises against using pillows, positioning devices, or special mattresses in the crib for infants under 12 months due to SIDS risk. Repositioning strategies and increased tummy time are safer alternatives.

Will my baby’s flat spot get worse?

Flat spots typically peak around 3-4 months of age when babies spend the most time lying down. As babies become more active and mobile, pressure on the head decreases, and the shape usually improves.

Does a flat spot mean my baby’s brain isn’t growing properly?

No. Positional flat spots are external shape changes and do not affect brain development. Your pediatrician monitors head circumference to ensure proper brain growth.

How long does it take to fix a flat spot?

Improvement timelines vary. With consistent repositioning, noticeable changes may occur within weeks to months. Helmet therapy typically lasts 2-6 months. Many flat spots continue improving gradually throughout the first year and beyond.

Is helmet therapy painful or uncomfortable?

Properly fitted helmets should not cause pain. Some babies need an adjustment period, but most adapt quickly. The helmet may cause minor skin irritation, which can be managed with proper hygiene and fit adjustments.

Supporting Your Baby’s Healthy Development

Discovering that your baby has a flat spot or uneven head shape can be concerning, but remember that this is a common issue that rarely indicates serious problems. The flexibility that allows these shape changes also means that with time and appropriate interventions, most irregularities improve significantly.

Focus on providing your baby with varied positioning, plenty of supervised tummy time, and opportunities for movement and exploration. Work closely with your pediatrician to monitor your baby’s head shape and overall development. Whether your baby needs simple repositioning, physical therapy, or more intensive treatment, early attention typically leads to excellent outcomes.

Above all, enjoy this precious time with your infant. With proper care and monitoring, most head shape concerns resolve, allowing you to focus on the joy of watching your baby grow and develop.

Sources:

• Mayo Clinic – Infant and Toddler Health
• American Academy of Pediatrics – Plagiocephaly
• Seattle Children’s Hospital – Plagiocephaly
• Children’s Hospital of Philadelphia – Positional Plagiocephaly
• Stanford Children’s Health – Positional Plagiocephaly
• Cincinnati Children’s Hospital – Plagiocephaly