DISCLAIMER: This material is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it. It is not intended to provide medical advice, diagnosis, or treatment, nor does it replace the advice or counsel of a doctor or health care professional. Reference to a specific commercial product, service, or external web site does not imply endorsement or recommendation of that product, service, or external web site content by CPCMG. We attempt to keep lists of resources and referrals as up to date as possible; however, this information is constantly changing. Please check with the service provider and your insurance company to verify coverage.
Information about abnormal head shapes in babies, especially when caused by the positions they spend most of their time in.
What is a positional skull deformity?
A change in the shape of a baby’s head or skull resulting from spending a lot of time in one position.
For some babies, this can happen because of positioning before or during birth.
More often, it happens in the first 4 to 12 weeks of life - when babies are not able to sit up or move on their own.
What causes a baby’s head shape to change?
A baby’s skull has soft, bony plates that haven’t yet fused together. This allows the bones to move and help the baby pass through the birth canal. It also gives room for babies' brains to grow. But, it also means that their shape can be affected by their environment.
A change in a baby’s head shape usually is related to the position in which they spend the most time. Your pediatrician can determine whether your baby’s head shape is caused by a positional skull deformity or an uncommon but more serious condition called craniosynostosis.
Before or during birth
Being a twin or triplet
Tight or unusual positions in the womb can lead to changes in head shape.
Prematurity
Many premature infants spend extra time in the hospital after being born and most of that time is spent lying flat on their back. This can make it more likely for their head to change shape.
Premature babies also have softer bones that are not as fully formed as the bones of full-term babies, making them more likely to develop flat areas due to the pressure of different positions.
Birth complications
The baby’s position when moving through the birth canal can affect their head shape.
Some other things that affect a baby’s head shape at birth are: using forceps, vacuum extraction, or even a difficult labor.
After birth
Preferred head position
Some babies like sitting or sleeping with their heads turned a certain way.
Not enough tummy time
Infants, especially newborns, spend most of their time laying on their back because this is the safest sleep position for them.
This puts pressure on the back of their head, causing the skull to flatten out.
For this reason, it is important for a baby to spend time playing on their stomach (commonly called “tummy time”) when they are awake and being supervised.
Not only is tummy time important for head shape, it also helps babies learn important new basic skills like head lifting, turning over, sitting up, and crawling.
Torticollis
This is when the muscles on one side of the neck are tighter than normal, leading to the baby’s head and neck staying in a preferred position.
85% of babies with torticollis will have a positional skull deformity.
What are the different types of abnormal head shapes?
Plagiocephaly
The most common type.
Often parents will be the first to notice the flat spot.
The back of the baby's head is flat on one side. Over time, the flattening may worsen - causing the ear, forehead, and jaw to move.
This is often seen in babies who prefer to sleep with their heads turned to one side and those with torticollis.
Brachycephaly
The second most common type.
The back of the head is flat instead of curved. It can be evenly flat on both sides – making the baby’s head wider and their ears might roll forward.
This is often caused by spending too much time lying on their back or in equipment such as car seats or swings.
Dolichocephaly
Flattening of the head from side to side.
It is common in babies who were in a “bottom-down” or breech position before they were born.
It also can occur if the head is often positioned side to side for long periods.
This sometimes occurs with premature babies who spend time in a neonatal intensive care unit.
Scaphocephaly is a type of dolichocephaly.
It happens when some of the bones of the skull close too early.
Parents will be able to feel a ridge across the skull. Please contact your child’s primary care provider if you are worried about this.
What are the symptoms of plagiocephaly?
In addition to having a flat or abnormally shaped head, infants with plagiocephaly may also have some of the following conditions:
Torticollis - This is when a baby prefers to keep their neck bent or turned in one direction due to tight muscles in the neck.
Face asymmetry - The sides of the baby's face may appear unequal or uneven. The jaw may appear to be more forward on the flattened side. Their ears may look uneven.
If left untreated, head shape deformities could lead to:
Feeding issues - the baby may not latch on to the breast or bottle initially and may have trouble transitioning to solid foods or textures.
Poor fit of sports helmets.
Poor fit of eyewear.
How is plagiocephaly diagnosed?
Let your baby’s primary care provider know if you are worried about the shape of your baby’s head.
They should rule out craniosynostosis – when the bones of the skull join together too early. This may include imaging studies, referral to physical therapy, or referral to a neurosurgeon or plastic surgeon.
How can I prevent my baby from having a flat head?
Here are some things caregivers can do to create the best developmental environment for their baby:
When your baby is awake, position them to avoid pressure on the back of their head as much as possible.
Your baby should be in their car seat only during travel times.
Limit time in all infant containers – like seats, bouncers, jumpers, and swings. Not more than one to two times per day for up to 15 minutes each time is best.
Start tummy time soon after birth.
All tummy time should be supervised.
Your baby might not like tummy time at first – you can start with small periods of time and work up to 30-60 minutes or more.
Carry or hold the baby in your arms or use a wearable baby carrier in ways that avoid pressure on their skull.
Change the baby's position often.
Change the "head of the bed" direction in the baby's crib or bassinet. This will encourage your baby to turn their head to the non-preferred side.
How is this treated?
When found early, simple changes for your baby’s position can help. These include:
Avoiding too much time in a car seat, bouncy seat, baby swing, or carriers.
Increasing tummy time when your baby is awake and being watched.
Alternating the arm you use to hold or feed your baby.
Alternate the end of crib you place your baby in for sleep.
Your baby’s pediatrician might recommend specific exercises or positions.
In some cases, your baby’s primary care provider may recommend additional treatment for positional skull deformity, especially those with moderate or severe flattening.
Physical therapy
Your pediatrician may refer your baby for early intervention services and an evaluation from a pediatric physical therapist.
The therapist will check your baby for delayed motor skills caused by poor head and neck control, and for torticollis.
You will also learn stretching and positioning exercises to do with your baby at home.
The physical therapist will decide how often physical therapy is needed based on how severe the skull deformity is.
Helmet therapy
If your baby has moderate or severe flattening that does not respond to treatment by 5 or 6 months of age, they may need helmet therapy.
These helmets work by re-shaping the baby’s head and are fitted by a specialist.
Surgery
Only considered when all other options have been exhausted, and after consulting with a neurosurgeon or pediatric plastic surgeon who specializes in these types of cases.
When to call your healthcare team:
You are concerned about the shape of your child’s head.
You are concerned about your child’s growth or development.
You have other questions or concerns.
📚 References
This publication was adapted from information from American Academy of Pediatrics Patient Education Materials, American Academy of Pediatrics Section on Neurological Surgery and Section on Plastic Surgery, patient education materials from the Academy of Pediatric Physical Therapy, and Rady Children’s Hospital of San Diego Physical Therapy Department.
Reviewed by: AR D.O., SC M.D., MB D.P.T., TT D.O., JW M.D. | 04/2026