Does Your Baby's Head Have a Flat Spot? What To Do

Campaigns urging parents to put infants to sleep on their backs have saved young lives, reducing the incidence of Sudden Infant Death Syndrome (SIDS). But one result of the safe sleep movement is that more babies develop misshapen heads from lying on their backs all the time.

Called flat head syndrome or positional plagiocephaly, a misshapen head typically is not a serious problem, but it does requires medical attention. Positional plagiocephaly may present as a flat spot on part of the head or on the whole back of the head.

Not all cases are caused by sleeping babies on their backs. Plagiocephaly can happen in utero or when tight muscles on one side of the neck keep the baby’s head in the same position.

Some simple measures can help reduce the risk and severity of flat head syndrome:

• Engage in lots of supervised play time while your baby lies on his or her tummy.
• Change your baby’s position in the crib often by reversing the position of the head and feet, so your baby isn’t always resting on the same part of the head.
• Limit your baby’s time in carriers and car seats.

Getting Proper Evaluation

If your baby’s head has a flat spot, experts recommend seeing your pediatrician or a specialist for evaluation, says Krystal Tomei, MD, MPH, chief of pediatric neurosurgery at UH Rainbow Babies & Children’s Hospital. 

“We see this quite frequently,” Dr. Tomei says. “Infant skulls are soft and malleable. When they spend a lot of time lying down, the skull can flatten. Anywhere from 20 percent to 50 percent of kids develop this nowadays as a result of the ‘Back to Sleep’ campaign.

With certain head shapes, doctors will want to rule out a deformity called craniosynostosis, an abnormal fusion of the growth plates. That is a more serious problem that is referred to pediatric neurosurgery and plastic surgery experts and requires surgery.

Pediatric neurosurgery and plastic surgery team members can usually determine from physical exam whether a baby has positional plagiocephaly. 3D photos can determine exact measurements, which helps guide treatment.

“Most of the time, we don’t need a scan or other imaging tests to diagnose or treat flat-head syndrome,” Dr. Tomei says. “Sometimes we will order an ultrasound, X-rays, or a CT scan if craniosynostosis is suspected,”

Treatment Options

While babies should still always be placed on their backs to lower risk of sudden death, mild cases of positional plagiocephaly can be corrected with positional changes to keep the baby off the flat spot.

“We usually start with keeping baby off the flat side of his or her head to help with rounding out the head,” Dr. Tomei says. “This can be done by turning the head toward the other direction, or doing lots of tummy time throughout the day while the baby is awake and you are watching.”

Sometimes, if the positioning doesn’t work to round out the head, or if the baby has very severe flatness, doctors recommend a helmet. Babies may need physical therapy or start neck stretching if the baby has tight neck muscles that make changing positions difficult.

Because an abnormal head shape in a baby should be properly evaluated to determine if it is plagiocephaly or craniosynostosis, parents should not purchase a shaping helmet without their baby having proper medical evaluation, she says.

“Our teams are aware of the most current guidelines regarding helmet therapy and use those to determine if a baby would benefit from a helmet,” Dr. Tomei says. “We are able to evaluate how severe it is and when it’s appropriate to refer them for a helmet.”

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University Hospitals Rainbow Babies & Children’s Hospital provides expert pediatric care for infants, children and adolescents. With expertise in 16 medical and 12 surgical specialties, our team of doctors, nurses and other clinical staff has experience in diagnosing and treating children for a range of medical issues, from common childhood illnesses to complex conditions. Learn more about the nationally recognized medical care at UH Rainbow Babies.