Who Should I See If My Baby Has a Flat Head?

Noticing that one side of your baby's head looks flatter than the other can be unsettling, particularly when you have been carefully following safe-sleep advice. Flattening of this kind is common, it is usually related to position rather than anything you have done wrong, and there is a clear pathway for getting it looked at.

Why flat spots happen

A young baby's skull is soft and grows quickly. Babies also spend a great deal of time lying down, which is exactly what safe-sleep guidance requires. If a baby tends to rest their head in the same position most of the time, that part of the skull can flatten. This is called positional plagiocephaly, and more than a third of babies show some degree of it in the early months.

A very common reason for a strong head preference is tightness in one of the neck muscles, known as congenital muscular torticollis. Where this is present, the flat spot and the head tilt or turn tend to travel together, and treating the neck is a key part of improving the head shape.

Who to see, and in what order

• Your child health nurse or GP is a good first stop. They can examine the head shape, check neck movement and arrange referral if needed.
• A paediatric physiotherapist assesses neck movement, muscle tightness, posture and motor development, and teaches positioning and stretching. You can book a physiotherapist directly in Australia; a referral is not required for a private appointment.
• A paediatrician, craniofacial or orthopaedic service is involved where the head shape is unusual, severe, worsening, or where a sutural problem is suspected.
• Helmet (cranial remoulding) therapy is considered only in selected moderate to severe cases that persist despite good repositioning and physiotherapy, and only after specialist assessment. It is not a first step.

What helps at home

• Keep placing your baby on their back for every sleep. Safe sleep comes first, always.
• Vary head position while your baby sleeps by alternating which end of the cot you lay them at, so they turn towards the room in both directions.
• Plenty of awake, supervised tummy time, built up gradually.
• Alternate the arm you carry and feed on, and vary which side you approach the cot or change table from.
• Reduce prolonged time with the head resting against a firm surface: car seats, bouncers, rockers and prams, once you are out of the car or the walk is over.
• Position toys, lights and your own face on the side your baby turns towards less often.

Does a flat head affect development?

Positional flattening is a shape issue. It does not cause developmental delay in itself. Most head shapes improve noticeably once a baby gains head control, starts rolling and spends more time upright, because the skull is growing fast and pressure is no longer concentrated in one place.

When is a routine check worthwhile?

Book a review if your baby strongly prefers one head position, has a tilt or turn to the head, resists turning one way, has a flat area that is not improving by around four months, has facial or ear asymmetry, or is finding tummy time very difficult. Earlier is better: neck treatment works best when it starts in the first few months.

When should I seek prompt medical advice?

Seek prompt medical review for a ridged or raised line along the skull, a head shape that is getting worse rather than better, a head tilt that appears suddenly or for the first time after six months of age, neck movement that is restricted in every direction, or a baby who is unwell, feeding poorly or unusually drowsy.

A reassuring takeaway

Most flat spots respond well to simple, consistent positioning changes, particularly when any neck tightness is treated at the same time. Getting it looked at early gives you the widest range of easy options.

Sources and further reading

Royal Children's Hospital Melbourne --- Positional plagiocephaly guideline

Royal Children's Hospital Melbourne --- Congenital muscular torticollis fact sheet

Red Nose Australia --- Safe sleeping

Suggested closing call to action

Still unsure about something you have noticed? A GP, child health nurse or paediatric physiotherapist can help you decide whether your child would benefit from an individual assessment. Contact PHYSITEK to ask about a paediatric physiotherapy visit.