Flattened Head Syndrome (Positional Plagiocephaly)

What is positional plagiocephaly?

Experts agree that putting babies to sleep on their backs is the best way to avoid Sudden Infant Death Syndrome. But if your baby spends too much time on his back in one position, he can develop a flattened skull. This skull flattening is called plagiocephaly (say: play-gee-o-SEFF-ah-lee). While plagiocephaly does not affect how a baby's brain develops, it can affect a baby's appearance by causing the head and face to develop unevenly.

This page explains what causes plagiocephaly and how to prevent it from occurring in your baby. A baby without plagiocephaly has a normally rounded skull and level ears.

Positional Plagiocephaly

A baby’s head can become slightly flattened is she lies on her back with her head turned in one position for a prolonged period of time.

What causes positional plagiocephaly?

Up until about one year of age, the bones of your baby's head are very thin and flexible. This makes your baby's head very soft and easy to mold. For the first few months of life your baby will not be strong enough to roll over on his own. If your baby prefers to look in one direction or if your baby is always on his back, part of his skull may become flat. This flattening is caused by constant pressure on one part of the skull. This is called positional plagiocephaly. Your baby may also develop a flat spot if he spends long periods of time in a car seat or reclining seat.

You may start to see flattening when your baby is only four to six weeks old.

How can you prevent positional plagiocephaly?

To prevent your baby from developing a flattened skull, change his position often. Put your baby on his tummy to play several times a day. Use a firm play surface such as a carpeted floor or an activity mat on the floor. "Tummy time" will also help your baby:

• develop early control of his head
• strengthen the muscles in the upper body
• learn to roll over
• reach for objects
• learn to crawl

You can also put your baby on his side to play. To keep your baby on his side, put a firm rolled-up towel or blanket behind his back.

If your baby dislikes "tummy time"

Babies don’t have a lot of strength to push up, so your baby may not enjoy "tummy time" to begin with. Here are some ways to help your baby learn to love playtime on his tummy:

• Holding your baby on your chest is a good way to get your baby used to lying on his tummy.
• Begin with short periods of time, two to three minutes at most. Put your baby on his tummy after each diaper change. Add a little extra tummy time each day.
• Give your baby lots of interesting things to look at. Put brightly coloured toys or a mirror directly in front of him.
• Give your baby support by putting a rolled towel under his chest. Prop your baby's arms in front of the towel.

If your baby looks in only one direction

Many babies prefer to look in one direction when they are lying on their backs. This is called positional preference. It is most common for babies to prefer looking to the right.

If your baby has a positional preference, encourage him to look to the less-preferred side until he looks equally in both directions. Here are some things you can do:

• When you are holding your baby during playtime, use mobiles or brightly coloured toys to encourage your baby to look in the less-preferred direction.
• While your baby is sitting in a seat or stroller, use a neck roll or a rolled-up blanket to keep the head in the centre.
• Carry your baby in your arms or in a front pack to encourage him to move his head in a variety of positions.
• If your baby's crib is against the wall, put your baby at opposite ends of the crib each night. Babies prefer to look out into the room.
• If your baby's crib is not against a wall, move a brightly coloured crib-safe toy to encourage your baby to look in a different direction each night.

To prevent Sudden Infant Death Syndrome, your baby should always sleep on his back.

What if your baby's head already has a flat spot?

If your baby's head has a noticeable flat spot that does not seem to be improving, you may still be able to reshape it. Talk to your baby's doctor about repositioning your baby while he is awake and while asleep. This is also known as counter-positioning. Counter-positioning takes the pressure off the flat spot so your baby's skull can round out as his head grows. It also encourages your baby to look to the less-preferred side.

Counter-positioning works best when your baby is less than six months old. This is because the skull is still soft and your baby is more likely to remain in one position.

How to counter-position your baby

If your baby has a flat spot, turn your baby slightly off his back at about a 45 degree angle. This will take the pressure off the flat spot. Use a crib roll to prevent your baby from rolling onto the tummy. Continue with this new position to keep your baby off the flat spot until your baby's skull becomes round and even.

When should you call your child’s health care provider?

If you have followed the suggestions on this page and your baby still has a noticeable flat spot at 6 months of age, speak to your baby's doctor to learn about other help available.

Key points

• To prevent Sudden Infant Death Syndrome, babies should always sleep on their backs.
• Baby flat-head can be easily prevented by changing your baby's position often throughout the day.
• When your baby is awake, give lots of supervised tummy time.
• If your baby's head already has a flat spot, counter-positioning (turning your baby slightly off his back at a 45 degree angle) can help to reshape the skull.

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