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What is 'flat head'?

If your baby has a flat head, it means that their head appears flat or asymmetrical. Most commonly, flat areas develop on the back or sides of a baby's head because of pressure. This is called positional plagiocephaly. It can be more obvious in babies without much hair.

Other names for a flat head are brachycephaly or misshapen head.

At least 1 in every 3 babies has a flat head in the first few months of life. This usually improves once your baby can sit up. Babies usually start to sit up on their own at around 5 months of age.

What symptoms are related to flat head?

It's common for newborns to have a differently shaped head than older children and adults. Generally, a baby's head returns to more of a usual shape within 6 weeks after birth.

If your baby has a flat head, they may also:

• have changes to the shape of their ears
• have changes to the shape of their face
• tilt their head
• prefer to turn their head to one side more than the other

What causes a flat head?

The bones in the skull (head) of a newborn baby are soft and not fully formed. It allows their head to be easily moulded to help with birth.

The skin-covered gaps where the skull plates meet are called fontanelles. If you touch the top of your baby's head you can feel these 'soft spots' in between the bones.

The shape of your baby's head is influenced by:

• their position in the uterus
• the type of birth
• the length of labour

Because the bones in your baby's head are thin and flexible, their head is quite soft and can change shape.

Young babies spend a lot of time lying down. If they are in one position for a while it puts pressure on one area of their head. Babies also have limited neck movement and head control. This combination of pressure and resting in the same position often leads to a flat area on their head.

Some babies are more likely to develop a flat head because they aren't very mobile, or it's hard for them to lift their head.

Babies who have (when the neck muscles are shortened on one side) are more at risk of plagiocephaly.

How is the cause of flat head diagnosed?

There are 2 main types of flat head.

1. Positional plagiocephaly — a common condition that often happens alongside torticollis in young babies.
2. Deformational plagiocephaly — a more severe condition that is diagnosed by a specialist physiotherapist when your baby is at least 4 months old.

To assess flat head, the doctor or physiotherapist will carefully examine your baby and ask about:

• your pregnancy and delivery of your baby
• your baby's preferred sleeping position
• tummy time
• how your baby moves their body

When should my baby see a doctor about flat head?

If you are worried about the shape of your baby's head, see your child health nurse or doctor. Often, changing your baby's position will make a difference.

If needed, you'll be referred to a physiotherapist who can assess the degree of head flattening and recommend treatment.

How is a flat head treated?

Most babies don't need any special treatment for a flat head, especially if they are becoming more active and learning how to sit up.

It's important to give your baby lots of opportunity to move around so they don't spend so much time lying in the same position.

Things you can do at home

When your baby is sitting up or on their tummy, their head is not supported by pressure from the cot mattress or floor. If your baby can sit on your lap and learn to hold their head up this can make a big difference.

The flattening tends to ease once there is less pressure on the same area of their head.

Here are some activities to try.

• From birth, offer your baby tummy time every day. When your baby is awake, place them on their tummy on a rug on the floor. Supervise them and stay close.
• Change your baby's position when they're having tummy time. Try to also place them on their side, taking turns with both sides for as long as they're happy.
• Hold your baby in different positions in your arms so they aren't always turning their head in the same direction to look at you.
• Hold your baby so they are looking outwards and can build their neck and upper body strength. Hold them over your arm, or on their side so they're looking outwards.
• Change the position of your baby's cot so they aren't always on the same side as they look out through the cot rails. If moving the cot isn't possible, change the end of the cot where you place your baby to sleep.
• Give your baby the chance to turn their head themselves when they are awake. Use your face and voice, brightly coloured toys and books with pictures to get their attention. Encourage them to turn their head both ways.

Specialist treatment for a flat head

Occasionally, specialist treatment is necessary to treat a flat head. Generally, a physiotherapist will recommend exercises and positions to improve head shape.

Sometimes referral to a paediatrician (children's doctor), plastic surgeon or orthotist is needed.

A small number of babies (less than 1 in 10) with plagiocephaly will need to be fitted with a helmet. Helmet therapy helps to reshape the skull by taking pressure off the flat area and allowing the skull to grow into the space provided.

How can I prevent my baby from developing a flat head?

It's important to vary your baby's position both when they are sleeping and when they're awake. This helps to prevent a flat area developing on their head.

What not to do when settling your baby

When putting your baby down to sleep, don't try to keep your baby in one position by using:

• pillows
• cot bumpers
• sleeping devices in their cot
• their car seat when you are not in the car

It's important for babies to learn to move around without being restricted.

Are there any complications from a flat head?

Flat head and plagiocephaly does not affect brain development. However, it can cause uneven growth of your baby's face and head.

Resources and support

Speak with your child health nurse or doctor if you are worried about the shape of your baby's head.

Visit to learn about safe sleeping positions for your baby.