Plagiocephaly (Flat Head Syndrome)
Plagiocephaly is a flattening of one part of a baby’s head, usually caused by consistent pressure on the same area while the soft skull is still growing. It is very common and, when addressed early, responds well to repositioning and physiotherapy. Flat head is often linked with torticollis (neck tightness), so we always assess the two together.
Types of Flat Head
- Positional plagiocephaly: Flattening on one side, giving the head an asymmetrical shape
- Brachycephaly: Flattening across the back of the head, making it appear wide and short
- Combination: Features of both
Why It Happens
- Spending long periods lying on the back (important for safe sleep)
- A neck preference or tightness (torticollis) keeping the head turned one way
- Premature birth and softer skull bones
- Limited tummy time and active head turning
- Sometimes positioning before birth
Signs and Symptoms
- A flat area on the back or one side of the head
- One ear pushed forward compared to the other
- Asymmetry of the forehead or face
- A strong preference to look or sleep facing one direction
- Associated neck tightness or head tilt
Assessment
Our paediatric physiotherapists assess the whole picture:
- Head shape: Mapping the areas of flattening and asymmetry
- Neck movement: Checking for torticollis or a turning preference
- Development: Confirming milestones are on track
- Severity grading: Helping decide whether referral for a helmet is needed
Physiotherapy Treatment
Repositioning Program
- Alternating head position during sleep and play (while always sleeping on the back)
- Rearranging the cot, toys, and room so your baby turns to the non-flat side
- Carrying and feeding strategies to reduce pressure on the flat area
Tummy Time
- Building neck and shoulder strength
- Reducing time spent with pressure on the back of the head
- Making tummy time enjoyable and progressively longer
Treating the Cause
- Stretching and exercises if torticollis is present
- Encouraging active head turning to both sides
Parent Education
- A clear daily plan you can follow at home
- Guidance on safe sleep alongside repositioning
- Regular reassessment to track head-shape improvement
When a Helmet May Be Considered
Most babies improve with repositioning and physiotherapy. For more significant or persistent flattening, we can advise whether a referral for cranial helmet assessment is appropriate, and coordinate with your paediatrician.
Expected Outcomes
Started early, repositioning and physiotherapy usually lead to:
- A noticeably more even head shape
- Full, symmetrical neck movement
- Normal motor development
Outcomes are best when treatment begins before around 6 months, while the skull is most responsive to change.
