What is Baby Flat Head Syndrome

What is Baby Flat Head Syndrome

Baby Flat Head Syndrome manifests in three basic shapes and it is not uncommon to see these shapes combined.

Baby Flat Head Syndrome must not be confused with the natural miss shaping that occurs during natural birth.

The head deformation from natural birth will generally round out with in 6 weeks.


Head is flat on one side and will resemble a parallelogram.

Generally caused by back sleeping with the head facing to one side.



Head is wider than its length and the back of the head is flat in appearance instead of curved.



Head is long and narrow

Generally caused by position in the womb or in NNICU where baby sleeps on either side of the head.



1.Back Sleeping

In 1995, America started the ‘BACK TO SLEEP” programme because of the large number of suffocation related cot death cases from babies sleeping on their stomachs.

The recommendation for baby’s to sleep only on their back worked!

SIDS related deaths decreased by 40%.

But from this time Craniofacial centres began to see a dramatic increase in Plagiocephaly.

Before 1995 there was an average of 1/300 Plagio cases recorded.

Later research shows that after 1995 1/80 American babies will have Plagio.

1/60 babies in Europe will have Plagio.

This is an increase of 500%!


2. Restrictive Womb Environment

Baby’s born with Plagiocephaly.

In this case, the infant does not have room to move, or becomes stuck in one position.

The may be caused by several sources: a very large or multiple number of foetuses (e.g., twins or triplets), a small pelvis, a small or malformed uterus, or if there is an excess or lack of amniotic fluid.

A breech orientation can lead to an abnormal head shape when the infant's head becomes wedged under the mother's ribs.

Mothers of children with Plagiocephaly often report experiencing pain in the hip, from pressure of the foetus on the pelvic wall.

There is nothing you can do while baby is in the womb so don’t panic. Everything is normal and you can get to work on the head soon enough.

3.Prem babies.

Bone density of infant cranial bones increases nearly 5–10 fold during the last 10 weeks of pregnancy.

Premature delivery makes the already soft cranium susceptible to moulding forces. Premature infants are also more likely to be physically delayed, preventing normal movement of the head. Preemies will often spend extended time in the Neonatal Intensive Care Unit (NICU) on a respirator with the head in a fixed position.

4.Baby’s environment.

Pillows, mattresses and play mats.

What feels soft for us is not soft to baby.

The average baby mattress has to be firm to prevent suffocation.

But protect your baby’s head with a good pillow.

Infant Car Seats, Carriers, Bouncy Seats and Swings
In recent years, it has been noticed that extended use of car seats, infant swings and bouncy seats also contribute to Plagiocephaly.

In these devices, the back of the head is against a rigid, unyielding surface, and the resulting deformity can be severe, even causing “cornering” or “squaring” of the head.

While normal use is not a concern, extended use, especially allowing infants to sleep in them, increases the risk of Plagiocephaly.


Now what?

You now realise that your baby’s head shape is not improving.

Now it is time for action.

Most important it to seek a Doctor that specialises in this field.

Your specialist will need to firstly rule out the possibility of Craniosynostosis and Torticollis.

But if after your baby has been cleared, and your Doctor says don’t worry about the head shape as it will fix its self,

or when the hair grows you won’t see the deformity,

or just give baby a hat.

You are in the wrong place.

Keep looking for someone that is up to date with the treatment of Plagiocephaly,

Contact Best For Baby for a specialist in your area.

Plagio Treatment

There is a window of opportunity to treat Plagio that closes after about a year.

When the baby gets older the bone density increases till it is not possible to correct without help.

The younger the baby, the easier and quicker it is to treat.

There are two phases of treatment of Plagio.

In babies younger than 3 months it is recommended to use Positional Therapy

And after 5 months it is recommended to use a helmet therapy.

Positional Therapy-

A body has an internal pressure, combine this with soft bones and Plagio can be treated over time like blowing up a soccer ball.

You need to keep your baby off the part of his head that is flattened.

Unfortunately your baby has this condition because their whole life they have preferred one position and now you need to break this habit.

This is not easy, as most babies will very quickly turn their heads back to their favourite position.

Tummy time- This is essential, Tummy Time helps your baby on so many different levels and is vital if you want to want positional therapy to work.

Bribery- Place baby at the opposite side of the cot so to make that baby can still face the world but the pressure is not on the flat spot. Use toys to encourage baby to face one way.

Wedges- a note must be made that in the America the FDA has issued a warning against the use of positional devises with babies that are old enough to wriggle themselves into a suffocationable position, as the positional devise will hold them in that position and the risk of suffocation is increased.

The American Academy of Paediatrics (AAP) does not recommend using any devices that might restrict the movement of an infant's head.

Please be careful with what you use around your baby.

Improvement usually occurs over a 2-3 month period. If you do not see improvement or the deformity continues to worsen, then you child will likely need an evaluation, the specialist might recommend that a molding helmet or band be used.

Helmet Therapy-

The most important head growth (12cm) takes place in the first year of life.

In the second year, head growth is only 2.5cm, so treatment after that time is unlikely to provide a satisfactory result.

Best head growth is from around 3 to 6 months and the  helmet uses this growth to correct the deformity.

Nearly everyone thinks of the helmet as a type of Forrest Gump contraption.

Something that squeezes the head back into shape. Far from this, pressure is the enemy of treatment.

The helmet works by resting gently on the high points and is hollowed out over the flat areas.

This encourages the low areas to catch up, when this happens then the cure is complete.

Duration of treatment is dependent on the age of baby.

The younger the baby is the better, as the baby is in the fastest growth curve. What can be treated in 2 months in a five month baby will take up to 5 months in a year old baby.

Research done in London showed that of a group of babies diagnosed with Plagio and left untreated, most of the group still had Plagio after 12 years.

Doc Band in America has had 55 000 success and 100% success with babies treated at the correct age.

Helmet therapy is in its infancy in South Africa and all the babies that followed treatment have been a success.


Follow this simple rule.

Alternate head direction at each activity and practice supervised, happy tummy time.

Tummy Time training can start at day one, the  best position for baby starts from birth when baby rests on mommy’s chest.

From this position baby can hear mom’s heart beat and her soothing voice. Sight, sound, touch and smell.

All of these senses will be filled and baby will feel more secure.

From day one baby can progress from mommy’s chest to tummy time.

It is more comfortable for baby to be supported under the chest.

Place your Best For Baby Pillow under baby with baby using the 2-4kg side as this will be more comfortable for baby.

Do not place other covers or pillow slips over the pillow and the Best For Baby Pillow is covered with a non suffocating cover that will help to protect your baby if the head drops down onto the pillow in the suffocation position.

It is important to make sure that tummy time is ‘happy’ time.

When baby starts to niggle because of sore muscles then it is best to give baby a break. It wont take long for baby to enjoy longer and longer periods of tummy time.

Each time your baby goes to sleep make sure that the head faces in the opposite direction.

It is vital for your baby’s safety that baby never faces directly up, as this head position does not allow liquids to drain from mouth and puts your baby at risk of chocking.

You can use toys (cot friendly)  that your baby likes and place them at the head to encourage baby to face in the direction that is wanted.

Sometimes baby likes to lie in the cot looking out at the room.

Parents can then change what end of the cot baby sleeps at to so that baby can always look out at the world.

The Best For Baby Mattress has integrated adjustable wedges at each end of the mattress that makes life easier for the parent and comfortable for baby.

Many cases of Baby Flat Head are caused by car seats and prams and it is important to ensure that baby has sufficient protection in these units and is not allowed to spend extensive time in them.

Practice alternating head direction in prams and It is also a good idea to alternate the head position when baby is in the car seat too.

It is vital to stay away from prams or car chairs that hold baby’s head in the face upright position as this will place baby at extreme risk of chocking.

Use your Best For Baby Pillow to protect your baby’s head from contact with a hard floor when using a play mat.