Understanding and Treating Flat Head Syndrome

As parents, it's natural to be attentive to every detail of your baby’s growth and development, including their head shape. Plagiocephaly, often referred to as flat head syndrome, is one of the most common cranial conditions in infants. While it can feel overwhelming to notice a flat spot on your baby’s head, understanding what plagiocephaly is and the steps you can take to treat or prevent it can make all the difference.

Let’s explore everything you need to know about plagiocephaly, from what causes it to treatment options and how to support your baby’s healthy head shape development.

[plā-jē-ō-sef-uh-lee] Plagiocephaly is a cranial condition where one side of the back of an infant’s head becomes flattened. It’s caused by external pressure applied to the soft and malleable skull, typically during the first few months of life.

What It May Look Like

• A flat spot on one side of the back of the head.

• Misaligned ears, with one ear appearing further forward than the other.

• Asymmetry in facial features, such as a slanted forehead or uneven cheekbones.

Plagiocephaly affects the shape and symmetry of your baby’s head and face, and severe cases can lead to long-term challenges, such as difficulties fitting helmets for work or play, glasses, or other protective gear. These asymmetries can also impact jaw alignment, potentially causing issues with chewing, starting solids, or overall facial balance. Early intervention ensures your baby’s head shape develops symmetrically, reducing the risk of these complications as they grow.

Several factors contribute to the development of plagiocephaly. Understanding these causes is the first step toward prevention and treatment.

1. Positional Preference

Many babies naturally prefer turning their head to one side during sleep or rest, which can result in flattening on that side over time. For example, your baby may always fall asleep looking in the direction of their parent, a light source, or a nearby toy, creating a habitual position that increases pressure on one side of the head.

2. Torticollis

Torticollis is a condition where tight neck muscles make it difficult for a baby to move their head freely. This limitation can cause the baby to rest in the same position for long periods of time, leading to rapid development of plagiocephaly.

3. Prolonged Back-Sleeping

Placing babies on their backs to sleep is the safest way to reduce the risk of SIDS. However, when a baby consistently lies on their back without alternating head positions, it can lead to flattening on one side of the head.

Tip: To avoid this, alternate the direction your baby’s head faces during sleep or switch the end of the crib where you place their head each night.

4. Limited Tummy Time

Without adequate tummy time, babies spend more time on their backs, increasing the likelihood of developing flat spots.

Tip: Start tummy time as early as possible once returning home from the hospital. Begin with 2-3 minutes, 2-3 times a day, and gradually increase to 20-40 minutes per day by the time your baby is 3-4 months old.

5. Prematurity

Premature infants have softer skull bones and often require respiratory support in the NICU, which keeps their head in one position for extended periods, affecting symmetrical head growth and potentially leading to plagiocephaly.

6. Lifestyle Factors

Prolonged use of car seats, swings, or bouncers, where a baby’s head remains in a reclined position for extended periods of time, can also contribute to the development of plagiocephaly.

Treatment for plagiocephaly varies depending on the severity of the condition and your baby’s age. Here are the most common treatment options:

1. Repositioning Techniques

Repositioning is one of the first-line approaches to treating mild cases of plagiocephaly, especially when detected early (before 4 months of age).

• Alternating Sleep Positions: Change the direction your baby’s head faces during naps and nighttime sleep.

• Increase Tummy Time: Encourage your baby to spend more time on their tummy while awake to reduce pressure on the back of their head.

• Limit Time in Devices: Avoid overuse of car seats, swings, and bouncers where the baby’s head remains in a fixed position.

• Engage in Active Play: Use brightly colored toys, mirrors, or sounds to encourage your baby to turn their head in different directions during playtime, promoting balanced neck and head movement.

2. Pediatric Therapy

If you notice a flat spot on your baby’s head before 4 months of age, consulting a pediatric physiotherapist, chiropractor, or osteopath, etc. can help. These professionals can assess your baby for conditions like torticollis and provide tailored exercises and treatment to improve neck mobility and encourage symmetrical head shape development.

3. Cranial Remodelling Orthosis (CRO)

For moderate to severe cases or when repositioning alone isn’t effective, a custom-designed cranial remodelling device like a ROKband may be recommended.

• ROKband gently redirects skull growth to the flatter areas, helping to restore symmetry.

• Treatment is most effective when started between 4-6 months, while the skull remains highly malleable and babies are experiencing rapid growth,  however we are able to assess and treat up to 18 months old.

While not all cases of plagiocephaly can be prevented, there are several proactive steps parents can take to reduce the risk:

• Prioritize Tummy Time: Start tummy time from birth, gradually increasing its duration as your baby grows. Begin with 1-2 minutes per session, 2-3 times a day, and gradually increase as your baby gets stronger and more comfortable. By 3-4 months of age, aim for at least 20-40 minutes of tummy time daily, broken into shorter sessions throughout the day. 

As your baby progresses, incorporate interactive elements like toys, mirrors, or tummy time on your chest to keep them engaged and encouraged.

• Alternate Sleeping Directions: Alternate the direction your baby’s head faces in the crib each night. Rotate your baby’s position in the crib or bassinet nightly by placing their head at the opposite end. This encourages them to naturally turn their head in different directions, reducing consistent pressure on one side.

• Monitor Your Baby’s Head Shape: Regularly check your baby’s head for flat spots or asymmetry, especially in the first 4 months of life,  and use repositioning techniques to address any concerns early.

• Encourage Active Play: Use toys, mirrors, or sounds to motivate your baby to turn their head to different sides.

• Limit Time in Reclined Devices: Reduce time spent in car seats, swings, and bouncers when your baby is awake.

The earlier plagiocephaly is identified, the easier it is to address. During the first four months of life, a baby’s skull is highly malleable, making repositioning techniques and tummy time most effective for preventing or correcting mild flattening. If you notice a flat spot during this critical period, early intervention with repositioning and guidance from pediatric health professionals can often help improve the concern.

If your baby is 4 months or older and you haven’t seen improvement or still have concerns, we recommend scheduling a free head shape assessment at ROKband. At this age, cranial remodelling orthoses (CRO), like the ROKband, are particularly effective because the skull is growing rapidly and we are able to redirect new growth to the desirable areas in order to create symmetry. 

We treat babies from 4 months up to 18 months, with early treatment offering the best chance for optimal results. Below are some key reasons why early detection and intervention are so important for treating plagiocephaly effectively:

• Improved Symmetry: Correcting the head shape early prevents worsening asymmetry and give you baby the likelihood of the best possible outcomes.

• Fewer Long-Term Complications: Untreated plagiocephaly can increase the risk of difficulties with fitting helmets for sports or work, glasses, and worsening facial asymmetry. While cranial remodelling orthoses can help improve head shape and symmetry, addressing related issues like neck mobility or motor milestone delays often requires additional support from pediatric practitioners such as physiotherapists, chiropractors, or osteopaths, etc. Early intervention ensures your baby’s head shape develops symmetrically and reduces the likelihood of these challenges as they grow.

• Reduced Stress for Parents: Starting treatment early leads to faster results, allowing families to return to their regular routines sooner. It also ensures parents can enjoy everyday moments like cuddles and skin-to-skin bonding without worrying about prolonged corrective measures. By addressing plagiocephaly early, you’re providing your baby with the best foundation for growth and development.

At ROKband, we stand apart from other providers because of our dedication to innovation, comfort, and expert care. Here’s what makes our CRO designs different:

• Advanced 3D Scanning Technology: We use precise 3D, LED light scanning technology to capture the exact shape of your baby’s head, ensuring that each CRO is custom-designed to deliver optimal results. 

• Tailored Design: Every ROKband CRO is custom-designed using specialized CAD/CAM technology to fit each baby’s unique head shape. Our orthotists take the time to review every scan and design each ROKband to ensure the fit is both corrective and comfortable.

• Lightweight Materials: Our CROs are made with hypoallergenic materials designed for comfort. ROKbands are 1/2 the weight and 1/3 the thickness of other helmets so babies can participate in daily activities without being hindered by a bulky helmet.

• Breathable: ROKbands have been engineered with increased ventilation to make them as much as 4 degrees cooler. This minimizes the discomfort of sweating, skin irritation, and unwanted odours.

• Aesthetic Choices: We offer a variety of fun, customized and colorful designs to make the experience enjoyable for both babies and parents.

Conclusion: Support for Every Step of the Journey

Understanding plagiocephaly and taking proactive steps—whether through repositioning, pediatric therapy, or alternative treatments like the ROKband—can make all the difference in your baby’s development.

If you’re feeling unsure or worried about your baby’s head shape, we’re here to help every step of the way. Schedule a free head shape assessment today at one of our ROKband clinics across Canada to learn more about your baby’s needs and the most effective solutions. Early action ensures your baby grows with a healthy, symmetrical head shape—and a bright future ahead.