The bones of a newborn's skull have not yet fused; this flexibility helps during birth, but in the first months it can also let the head flatten on the side that presses constantly. This flattening at the back or on one side of the head is called positional plagiocephaly.

It is usually not a disease but a consequence of position, and it does not affect brain development. Even so, when noticed early it can largely be prevented with simple measures.

Why does it happen?

  • Always sleeping with the head turned to the same side
  • Too little tummy time while awake
  • Long periods in a bouncer, car seat or swing (the head presses on the same point)
  • Premature birth (the skull is softer)
  • Torticollis: the head always turning one way because of a short neck muscle

It is certain that sleeping on the back reduces the risk of sudden infant death, and this is not abandoned. The aim is to keep back sleeping while varying position during the day.

How is it assessed?

Head shape is best judged from above. Look for:

  • Marked flattening at the back on one side
  • Whether the ear on that side appears pushed forward
  • Asymmetry in the forehead and cheek lines
  • Whether the baby can turn the head equally easily both ways

A small proportion of head shape problems come from early closure of the skull sutures (craniosynostosis); this differs from positional plagiocephaly and is distinguished on examination. That is why a single assessment is recommended rather than assuming it will pass.

What to do at home

  • Tummy time: while the baby is awake and supervised, start with short sessions several times a day and build up. It is the single most effective practice for muscle strength, head control and head shape.
  • Change the head direction: lay the baby sometimes facing right, sometimes left. Turning the cot around or moving an interesting toy also helps.
  • Alternate the feeding side; if bottle feeding, alternate the arm you hold the baby in.
  • Reduce time in seated devices: the car seat is for the car, and a bouncer only for short periods.
  • Special pillows and shaping products are not recommended; they are also unsafe for sleep.

Torticollis: the frequent companion

A considerable proportion of babies with a flat head also have a short neck muscle. Signs:

  • The baby always turns or tilts the head to the same side
  • Resists turning to the other side
  • Clearly refuses one side when breastfeeding

Torticollis responds very well to early physiotherapy and stretching exercises. Exercises must be done exactly as taught; forcing the baby's head around is not correct.

When does helmet therapy come up?

For most babies it does not. A helmet is considered for marked asymmetry that does not improve with positional change, in the 4-6 month period when head growth is fastest. The decision is made with measurement and examination, and regular follow-up is needed.

When to see a doctor

  • If the flattening is marked and increasing after two months
  • If there is asymmetry of the ear, forehead or face
  • If the baby struggles to turn the head one way
  • If there is a hard lump, or a rapidly growing or tense area on the head

Other articles on development: month-by-month development in babies and 2-month-old development. For your baby's head shape and neck movements you can book an appointment at Özel Düztepe Yaşam Hospital in Şahinbey.