Positional Plagiocephaly :: Nationwide Children's Hospital

Helping Hand Logo

 

Positional Plagiocephaly (Flattened Head)

Positional plagiocephaly (play gee o SEF uh lee) is a flat area on the back or on one side of your baby’s head that does not go away on its own.

A newborn’s head bones are soft. This helps them pass through the birth canal. It may take a few days or even weeks for your baby’s head to round out. He or she may also have a flat spot on the head. It is normal for your baby’s head to be slightly misshaped for a few weeks.

Causes of Flat Spots

  • Baby’s position in the womb that puts pressure on the head.
  • More than one baby in the same pregnancy.
  • Too much time on her back.
  • Premature babies have softer skulls and spend more time on their backs because of longer stays in the hospital.
  • Torticollis (tor ti COL lis), which is a tight muscle on one side of your baby’s neck, may cause her head to tilt one way or make it hard for her to turn her head.

You should ALWAYS put your baby to sleep on her back (Picture 1). Putting your baby on her back is one of the best ways to prevent SIDS (Sudden Infant Death Syndrome).

Diagnosis

Your baby’s doctor can usually diagnose the cause of flat spots by examining your child’s head shape. The doctor will watch your baby to see whether the shape of her head improves as she grows or if treatment is needed.

Picture 1 Place baby on her back to sleep.

What to Do

There are several ways to help shape of your baby’s head. Some of the choices are:

Positioning Activities for Plagiocephaly

Start positioning activities as soon as possible will help to better re-shape your baby’s head. As your baby gains head control, she will be able to look to both her left and right sides. Lying on the side of her head that is not flat will help re-shape her head.

When Your Baby Is On Her Back

When your child is on her back, gently turn her head to the side that is not flat. This is her “non-preferred side”. Changing sides takes pressure off the flat spot. Do not use anything to hold her head in place. This might block her face and then she won’t be able to breathe. Try turning her head to her non-preferred side when she is sleeping. Do not do this if she wakes up each time.

During diaper changes, move toys to her non-preferred side to encourage her to turn her head to look at the toy and take pressure off of the flattened side of her head.

When Your Baby Is Not on Her Back

WHEN YOUR BABY IS NOT ON HER BACK, ALL ACTIVITIES MUST BE SUPERVISED BY AN ADULT.

When she is awake, limit the time your baby spends in swings or baby carriers. If your child is able to, have your baby sit up. Sitting takes the pressure off the back of your baby’s head and builds her neck strength. Infants should not be sitting all the time. They need supervised play time on the floor to work on reaching, rolling, and pushing up on their tummies. These activities are important for building strong muscles for sitting and crawling skills.

When you hold your baby make sure there is no pressure on the flattened side of her head. Give her fun things to look at so she turns her head side to side.

While watching your baby, place a toy or Velcro a wrist rattle to your child’s left or right hand to encourage them to look toward their non-preferred side and take pressure off of the flattened side of her head. You can also hold toys at their non-preferred side to encourage looking in that direction.

Check with your baby’s doctor for more advice.

Tummy Time

Picture 2 Tummy time with a toy.

A baby needs time on her tummy each day while awake, with an adult watching her. (Picture 2). This helps the baby stretch and strengthen the back, neck and arm muscles. It also helps keep a round head shape. Start this slowly for 1 to 2 minutes at a time. Give the baby something interesting to look at or play with while on her tummy to encourage her to turn her head away from the flat area (See Helping Hand, Tummy Time, HH II-173).

A BABY MUST BE AWAKE AND SOMEONE MUST BE WITH HER WHILE SHE IS ON HER TUMMY.

Exercises

If your baby has torticollis, the doctor may teach you exercises to stretch your child’s neck or may refer you to a physical therapist to learn how to do the exercises (See Helping Hand, Exercises: Left Torticollis Stretching and Positioning for Play, HH-II-163 and Exercises: Right Torticollis Stretching and Positioning for Play, HH-II-164).

Helmets or Bands

Some infants may need a custom-made helmet or band. The helmets work by applying gentle pressure to areas of your baby’s head. Your baby’s doctor will let you know if this is the right treatment for your baby.

Positional Plagiocephaly (PDF)

HH I-336 6/13 Copyright 2011, Nationwide Children's Hospital

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000