Positional Skull Deformity

(Flat Head Syndrome; Plagiocephaly; Brachycephaly; Scaphocephaly)


Flat head syndrome is the flattening of an infant’s head due to continued pressure on one spot. These changes to the skull cause the head to look distorted, but are purely cosmetic and not associated with problems of brain function or growth.

There are 3 common types of flat head syndrome:

  • Plagiocephaly—flattening on one side of the bone on the back of the head
  • Brachycephaly—equal flattening on both sides of the bone on the back of the head
  • Scaphocephaly—equal flattening of both bones on the side of the head (more common in premature infants)

Infant Brain and Skull

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Infant’s skulls are softer than older children. A softer skull is a normal part of growth and development, but can make the skull more vulnerable in the first few months after birth. Pressure on a softer skull can cause a change in the shape of the head. The pressure is most often caused by long periods of time with the head resting in the same position. Since young infants have little control over head movement they are more likely to spend long periods of time in the position they are placed in.

Older infants are less vulnerable to these changes because their skulls become harder and they are better able to control their head movements.

Risk Factors

Factors that may increase your baby’s chances of flat head syndrome include:

  • Preference for sleeping or laying in the same position
  • Preference to turn the head to one side and turn the chin to the other—torticollis
  • Babies who are born prematurely
  • Babies with weak muscles who cannot move their head around


Babies with flat head syndrome have a flattened spot on one area of the head. Flattening on the back of the head may also result in distortions of the face on the opposite side.


The diagnosis can be made by physical appearance and physical exam.


Talk with your baby’s doctor about the best treatment plan for your baby. Options include:

Repositioning Your Baby

Regularly changing your baby’s position will relieve pressure on the affected area of the skull. Some steps include:

  • Position your baby throughout the day so that the head rests on areas that are not flattened. You may have to reposition the head often during sleep since your baby’s head may be inclined to move toward the flattened area.
    • Babies should always be placed on their back to sleep.
    • Do not use a pillow or other device to keep your baby in one position.
  • Tummy time can also help relieve the pressure on the skull. Make sure your baby is awake and supervised during tummy time.Try moving a light, a toy, or some other visual cue around the top of the crib so the baby will move their head to focus on it.

Physical Therapy

Physical therapy may be used to teach you exercises you can do with your baby. The exercises will include stretching your baby’s neck muscles and decreasing the preference to rest on one side only.

Helmet Therapy

If your baby’s condition is severe, a custom-molded helmet or band may be advised. The device will apply pressure on a baby’s skull to promote a more rounded head shape.

Your baby’s head shape will improve over time. Helmet therapy will only shorten the process.


To help reduce your baby’s chances of getting flat head syndrome:

  • Pay attention to your baby's head position. Alternate your baby’s position until your they are old enough to move independently.
  • Supervise your baby until they are able to roll easily and sit on their own. They spend 30-60 minutes a day on their stomach.
  • Minimize the amount of time your baby spends in car seats and swings.

Healthy Children—American Academy of Pediatrics

Kids Health—Nemours Foundation


Caring for Kids—Canadian Paediatric Society

Health Canada


Flat head syndrome (positional plagiocephaly). Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/positional-plagiocephaly.html. Updated October 2014. Accessed November 10, 2015.

Plagiocephaly and brachycephaly (flat head syndrome). NHS Choices website. Available at: https://www.nhs.uk/conditions/plagiocephaly-brachycephaly. Updated February 22, 2016. Accessed December 20, 2017.

Plagiocephaly in children. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/conditions-and-treatments/conditions/plagiocephaly. Accessed December 20, 2017.

Positional head deformity. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T905714/Positional-head-deformity. Updated April 10, 2017. Accessed December 20, 2017.

Positional plagiocephaly. American Association of Neurological Surgeons website. Available at: http://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Positional-Plagiocephaly. Accessed December 20, 2017.

Positional plagiocephaly. UCSF Benioff Children’s Hospital website. Available at: https://www.childrenshospitaloakland.org/main/Positional-Plagiocephaly.aspx. Accessed December 20, 2017.

Positional plagiocephaly in children. Seattle Children’s website. Available at: http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/positional-plagiocephaly. Accessed December 20, 2017.

van Wijk RM, van Vlimmeren LA, Groothuis-Oudshoorn CG, Van der Ploeg CP, Ijzerman MJ, Boere-Boonekamp MM. Helmet therapy in infants with positional skull deformation: randomised controlled trial. BMJ. 2014;348:g2741.

Last reviewed November 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP  Last Updated: 10/3/2016