Flat Head Syndrome in babies: diagnosis, prevention & treatment

by Dr Maraschin, expert paediatrician
Flat Head Syndrome
Reading Time: 7 minutes

Diagnosis: Why does my baby have a flat head?

How do you know if your baby has Flat Head Syndrome?

Usually the first stage in the diagnosis process of a baby with a flat head is the observation of the parents. Often parents will present to their healthcare provider with concerns about the shape of the head around 6 to 8 weeks of life.

Those children who do not have a flat head at birth may develop this condition after a couple of weeks of lying in a particular position for extended periods of time.

The healthcare provider will examine the baby and look for specific signs of Flat Head Syndrome.

These would include the movement of the head, symmetry of the eyes and ears. In other words, are the eyes in the same position on either side of the nose and are the ears in the same position on either side of the head?

Who treats Flat Head Syndrome in babies?

At this stage the healthcare provider may refer the baby to a physiotherapist, chiropractor or prosthetist who deals with Cranial Orthotic treatments.

A physiotherapist would assess the baby’s muscle strength and range.

The physiotherapist works on the baby to improve neck movement and would provide caregivers with exercises to do at home which would encourage better movement of the head and encourage motor development.

Certain paediatric chiropractors have techniques to assist with Flat Head Syndrome and the shape of the head.

The prosthetist is usually the professional who advises on the use of a helmet to correct the flat head.

The assessment usually involves very scientific measurements and tests looking particularly for adequate space inside the skull for normal brain growth and development.

flat head syndrome in baby: doctor measuring baby's head

How does Flat Head Syndrome affect a baby’s development?

Should I worry about my baby’s flat head? 

In mild cases of this condition the research seems to indicate that there is no long term effect on children either from a medical or neurodevelopmental point of view.

In the moderate to severe cases, parents and practitioners are advised not to treat this condition merely as a cosmetic problem. In other words doctors should not just assume that the flat head only affects the way the child looks.

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Flat Head Syndrome & development delays

Doctors are advised to be aware that Flat Head Syndrome may be associated with developmental delays, reduced gross and fine motor skills, hearing and sight problems, communication problems and a lowered ability to solve problems.

When a parent brings a child to the doctor because their baby’s head looks odd, parents are not generally worried about how their baby looks in photos but are more concerned that the strange shape is affecting their baby in some way.

So, should you be worried if your child has a flat head?

Recent studies confirm that parents are right to be concerned about the shape of their child’s head as it may well affect the baby’s future development.

It is still unclear whether Flat Head Syndrome causes these developmental delays or if a child with developmental delays is more likely to develop Flat Head Syndrome. Let’s leave this question for the academics to answer.

What you as parents need to know is that there is a possibility of developmental problems when a child has an odd shaped head so seeking advice and a treatment plan is critical.

How does a flat head cause problems in babies?

This is not an easy concept to explain but let me try to use an analogy which you will hopefully relate to. Imagine you are driving along the highway at 120km an hour. Suddenly you encounter one of those yellow barriers blocking your lane. You are forced to hit breaks and to wait and see when you are clear to change lanes and get going again.

A study performed in 2020 suggests that this is what occurs in the brain. Messages are rushing along the white material of the brain, carrying instructions for various parts of the body. They suddenly hit an obstruction in the form of the flattened skull and the instruction is either interrupted or slowed down.

The result of this interruption is delays in neurodevelopment, sight, speech and so on.

Since this is a new science, a lot more work in understanding Flat Head Syndrome is required. Having said this, the current studies use modern MRI techniques and have methods which make the study of white matter easier.

These studies suggest that a child with a flattened head requires intervention.
If you would like to look at the study, there is an abstract which you can read HERE.

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Can you prevent Flat Head Syndrome in a baby?

If your child is born with a flattened area of the head there is obviously nothing you can do to prevent it but some of these prevention techniques may help to improve the condition:

Preventing a flat head in a baby with tummy time

I cannot stress this enough. There is so much evidence showing why a baby needs to experience tummy time from day one.

Flat Head Syndrome is another reason to institute tummy time. While baby is still tiny you can institute tummy time by the way that you hold your baby.

This would include your baby:

  • Lying with its face on your chest
  • Lying over your lap
  • Leopard in the tree position where baby lies over your arm
  • On the floor, tummy down with a towel or blanket rolled under the chest.

baby with a flat head wearing treatment helmet: flat head syndrome in babies

Change the way baby spends his or her day

Carry your baby in a sling, put baby into a sloping chair or have the pram back slightly elevated if you are taking baby for a walk. This way baby won’t always being lying on the back of his or her head.

Change the position of mobiles and toys in the baby’s cot

Babies do like watching mobiles and brightly coloured toys so shifting their position in the cot will encourage your baby to turn their head.

Alternate the side of your body where you carry or feed your baby

Most parents carry or feed their baby favouring their own dominant side but this will also mean that baby is always in the same position.

Take notice of head movements

If you notice that your baby holds his or her head in a particular position and doesn’t easily move the head from side to side, consult a paediatric physiotherapist for help.

Use a blanket to ‘lift’ the baby on one side

If your baby appears to have or is developing a flattened head then I would suggest you roll up a little receiving blanket and put it under the head, shoulder, waist and hip of the affected side. This will lift that side of the body and take pressure off the side of the head affected when in the car seat.

We had a friend with a very premature baby. They used to change the position of the blanket each time the little one went in the car chair. This was to avoid the head developing flat spots. They used to call it her “panel beating”.

Choose good back support

If your baby is learning to sit then an upright chair with good back support is wonderful to get the pressure off the back of the head. This can be used from about 3 to 4 months of age and the length of time slowly increased.

Remove the baby from the car seat

A child must be transported in a car seat but I would propose getting the baby out of the car seat when you get to your destination. Leaving baby in the chair will increase the amount of time that pressure is kept on the head.

flat head syndrom in baby: baby doing tummy time and smiling

Will my baby’s flat head correct or fix itself?

If the flattening of the baby’s head has not improved by about 4 months of age then I would suggest that the child needs further intervention.

At this stage a helmet or headband may be indicated.

Does a baby with a flat head need a helmet?

The purpose of the helmet or headband is to apply pressure to the bulging part of the head. The treatment is usually started around the age of 5 or 6 months when the skull is still soft. The child needs to wear the helmet for about 23 hours a day at the beginning of treatment and for less time as the condition improves.

There are certainly challenges with regards to the helmet and these include:

  • The length of time that the child needs to wear it
  • Some medical aids do not pay for the helmet and the treatment is expensive. At present you are probably looking at around R40 000.
  • It can be uncomfortable.
  • Some children develop skin rashes, cradle cap and eczema.
  • The baby needs to be checked regularly so that the growth can be monitored and adjustments be made where necessary.

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Flat Head Syndrome is a relatively new concept. Around the world, centres that treat babies are experiencing ever increasing numbers of children with this condition. Views around treatment of Flat Head Syndrome vary and parents may find that they get conflicting views.

In my own practice I encourage parents to institute tummy time techniques from day one.

If babies are struggling to move their heads then I strongly believe in physiotherapists being consulted for torticollis.

I had a child come into my practice for the first time at age four. The child’s head was at such a strange angle that he walked completely skew. With a head that is off centre, a child is likely to suffer from Flat Head Syndrome but is also at a high risk of jaw issues, hip dysplasia and postural issues. This particular child was too old for helmet treatment but did go to physiotherapy to help correct the posture.

Helmet therapy for Flat Head Syndrome

With regard to helmet therapy for Flat Head Syndrome, the Congress of Neurological Surgeons (CNS) updated their guidelines to state that repositioning, tummy time, physiotherapy and chiropractics are important but concluded that:

“more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy.” Read more HERE.

Given all the new data I would certainly encourage parents and caregivers to institute all conservative methods to avoid or treat Flat Head Syndrome from day one. Hopefully these conservative measures will improve the child’s condition and avoid the knock on effects of untreated Flattened Head Syndrome.

If your baby still has a flat head by age three to four months then you should seek medical assistance.

In my discussions with Yovanka Torrente, a medical prosthetist and orthoptist she stated that “I have noted time and time again that my Brachycephaly patients are my late starters.”, meaning that these children achieve their milestones later than children without Flattened Head Syndrome.



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