What Causes a Flat Head

A baby’s head is remarkably soft and malleable in the early stages of life. This flexibility allows the skull to pass through the birth canal during delivery and provides room for rapid brain growth during infancy. However, this same flexibility can also lead to a condition commonly referred to as "flat head," or more medically, positional plagiocephaly.

This article will explore what causes a flat head, the different types of flat head syndrome, risk factors, and how parents and caregivers can help prevent or treat this condition.

What is Flat Head Syndrome?

Flat head syndrome is a term used to describe an abnormal flattening on one side or the back of an infant’s skull. The three most common types include:

  1. Plagiocephaly – Flattening on one side of the head, often accompanied by misalignment of facial features.

  2. Brachycephaly – Flattening at the back of the head, causing the head to appear wider than usual.

  3. Scaphocephaly – A less common form, where the head appears long and narrow due to premature fusion of skull sutures.

Common Causes of Flat Head Syndrome

1. Prolonged Pressure on One Part of the Head

The most common cause of flat head syndrome is consistent pressure on one area of the skull. Infants typically sleep for 12–16 hours a day, and if they favor one sleeping position, the constant pressure on a single spot can result in a flat area.

This is especially common in babies who:

  • Spend extended time lying on their back.

  • Prefer turning their head to one side.

  • Spend too much time in car seats, bouncers, or swings.

2. Torticollis (Tight Neck Muscles)

Some infants are born with a condition called congenital muscular torticollis, where tight neck muscles make it difficult to turn their head in one direction. As a result, the baby may consistently rest on one side of the head, leading to flattening.

Read More: What Is Flat Head Syndrome & How Can I Treat It?

3. Premature Birth

Premature infants are more susceptible to flat head syndrome because:

  • Their skull bones are softer than those of full-term babies.

  • They often spend more time lying on their backs in neonatal intensive care units (NICUs).

  • They have weaker muscle tone, making it harder for them to move their heads independently.

4. Multiple Births

Twins, triplets, or other multiples may experience restricted space in the womb. This constraint can lead to irregular head shapes at birth and an increased risk of plagiocephaly.

5. Intrauterine Positioning

The baby's position in the womb can contribute to skull flattening. If a baby rests against the mother’s pelvic bone or a sibling for an extended period before birth, it can affect the shape of the head.

6. Back Sleeping Recommendation

While placing babies on their backs to sleep has significantly reduced the risk of Sudden Infant Death Syndrome (SIDS), it has also contributed to an increase in positional plagiocephaly. However, back sleeping is still the safest sleep position, and steps can be taken to prevent flat head without changing it.

Prevention and Treatment

Fortunately, flat head syndrome is usually cosmetic and non-life-threatening. In most cases, it can be corrected with simple interventions:

  • Tummy Time: Supervised tummy time while the baby is awake helps strengthen neck muscles and relieves pressure on the skull.

  • Repositioning: Varying the baby's head position during sleep, feeding, and play can help prevent pressure from building up on one area.

  • Physical Therapy: For babies with torticollis or difficulty turning their head, physical therapy can help stretch and strengthen neck muscles.

  • Helmet Therapy: In severe cases or when other methods are ineffective, a specially designed helmet can gently reshape the baby’s head over time.

When to Seek Medical Advice

Parents should consult their pediatrician if:

  • The flattening is pronounced or getting worse.

  • The baby has trouble turning their head or seems to favor one side.

  • There are signs of early fusion of skull bones (craniosynostosis), which may require surgical intervention.

A specialist, such as a pediatric neurosurgeon or craniofacial expert, may evaluate more complex cases.

Final Thoughts

Flat head syndrome may seem worrisome to new parents, but it’s typically manageable with early detection and the right approach. Understanding the causes—such as sleeping positions or underlying muscular conditions—can help caregivers take proactive steps to prevent and address the issue. With consistent care and the right baby’s flat head treatment, including repositioning techniques or helmet therapy when needed, most infants go on to develop normally without any long-term concerns.

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