How to Fix Flat Head

Flat head, or plagiocephaly, is a commonly searched topic.

With celebrities placing their infants in helmets and everyone worrying about their baby’s head, there has to be a solid resource on how to fix this flattening!

Download our free “flat head” guide here to learn more about preventing & correcting “flat head” with your baby.

This topic is very common among new and seasoned parents, especially since the Safe to Sleep initiative. This initiative, formerly known as the Back to Sleep campaign, encourages safe sleeping positions for infants to reduce the risk of Sudden Infant Death Syndrome (or SIDS). This initiative was formed in 1992 and now leads to more head shape issues due to constant pressure on the baby’s soft head.

This Safe to Sleep initiative has been largely successful, in which the incidence of SIDS has been lowered by 60 percent after the AAP (American Academy of Pediatrics) encouraged parents to place babies on their back to sleep. With the significant decrease in SIDS, comes a significant increase in head shape issues. Now, 1 in 10 babies experience some flattening on their head due to their sleeping position. I, myself, am a firm believer in back to sleep as a safe sleeping position for infants. But, we have to be aware that head shape is a common issue and we need to understand ways to fix flat head. See this article for more info on how back to sleep has changed infant head shape and development!

Preventing and correcting head shape issues are two very important topics. But, correcting the head and preventing the head from becoming flat require two different approaches.

Let’s explore the differences in these two more in depth.

Preventing head shape issues is something that has to be done BEFORE flattening has occurred. Preventing this flattening involves things you can do from DAY ONE. These things are focused on preventing your baby from putting too much pressure on one side or on the back of their head. The head of an infant is so soft due to their need to fit through the birth canal during delivery, and allow continued brain growth through the first year. The head remains soft through the first year and up until as late as 24 months.

Ways to prevent flattening can look like many different things. These activities may be tummy time, baby carrying, placing baby in sitting or supported sitting once the baby is old enough, and sleeping with the head alternating directions each night.

Tummy time can be a point of contingency, but this position is very important in preventing head shape issues from arising. Try placing your baby with their chest elevated on a boppy or towel to encourage more tolerance in tummy time.

Baby carrying is also a great way to prevent flattening and is a great place for your baby to take naps, complete household chores with you, or rest from tummy time positioning. Be sure to place your baby’s hips in a safe “M” position for healthy hip development.

Placing your baby in sitting or supported sitting will encourage your baby’s head to remain round. This positioning can begin around 4 months, but lots of support will need to be provided to your baby. I love the prop-a-pillar which can be used as a supported sitting device one your baby exhibits good head control. You can find this product here. Once your baby is sitting independently and does not have any signs of flattening, this is a great position to continue to prevent the head from becoming flat.

Placing your baby’s head in a variety of positions each night will also significantly minimize the risk that your baby develops flattening on their head. I suggest implementing a head turn schedule where you encourage your baby to sleep left on MWF, right on TH, and with the head straight on the weekends. This will ensure there is no sustained pressure on any one area of the head resulting in a beautiful round head.

In additional to positional changes and minimizing the time your baby spends on the back or sides of their head, their neck should be stretched as well. Babies spend approximately 9 months in the uterus confined and cramped. This often times creates neck tension and tightness and can lead to a side preference after birth. This side preference can be corrected with proper stretching of your baby’s neck. See how to stretch your baby’s neck to reduce the risk of side preferences here.

Preventing flat head is HUGE and the ways to do so are very different than fixing a flat head. Check out my services here on preventing flat head in your infant! Preventing flat head is a topic that every parent should consider when bringing their baby home. Knowing how to prevent flat head, fosters confidence and minimizes worry around this topic among parents!

So if preventing flat head and fixing flat head are different, then how do we correct the flattening!?

As stated above, flat head is caused by prolonged pressure on any one area of an infant’s head. This can be pressure on the side or the very back. Infants’ heads are very soft and may not form completely until as late as 24 months. This soft head and skull can be shifted based on the pressure applied. This shifting moves the sutures of the head which misaligns the skull plates. This leads to noticeable flattening of the baby’s head either on the side(s) or the back. This notable flattening is commonly referred to as brachycephaly (flattening on the back) and/or plagiocephaly flattening on the side). In order to fix the flat head, the sutures and skull plates of the head have to be realigned. See the photo below for a visual on the suture and skull plate shift in various head shape changes.

Correcting the flattening of your baby’s head can look several different ways. You can fix the flat head conservatively through repositioning and occupational / physical therapy. You can also complete helmet therapy where your baby is placed in a cranial helmet to correct the shape. Lastly, you may also find success in head shape correction through craniosacral therapy and chiropractic care. Below we will explore how to correct head shape through these various options.

Fixing your baby’s flat head conservatively through positioning and traditional therapy is something I am very passionate about. During traditional therapy, your baby’s body tension will be released through a multitude of stretches to encourage your baby to sleep to the non-preferred side. Traditional therapy will also consider your baby’s milestones and how they develop based on the tension and side preference. Traditional therapy may include strict repositioning to fix the flat head. Repositioning must be completed to round the baby’s head if flattening is already noted. Contralateral pressure or counter-pressure is required to the areas that bulge to ensure symmetrical head shape is restored. Ways to repositioning to round the head include positions in the crib, swings or bouncers, on the changing table, during play, and during feeding. Holding your baby is also a very important place to reposition your baby because you do not want any of the flattened area of the head to touch the surface. Be mindful of the way you hold your baby if they have flattening and switch arms in the flattening area is making contact with the surface! These methods tend to work best when the baby is less than 4 months if the head shape is in the severe range and less than 9 months for mild to moderate head shape changes.

Head shape and flattening is usually corrected best with repositioning to fix the flattening while concurrently reducing the body tension and encouraging proper milestone development. This is very important for rolling and crawling development in particular. The head and neck are very important in infant development as this is the first form of movement that develops, head control. Your head also determines your movement direction, so if your baby has tightness in the muscles of the neck, this can affect their movements due to limits in mobility. This can also affect your baby’s tummy time tolerance which affects their head control development. There are many stretches to complete with your baby including rotational, lateral, and the guppy stretch to ensure all muscles of the neck are elongated and mobile.

Download our free “flat head” guide here to learn more about preventing & correcting “flat head” with your baby.

This type of correction, through repositioning, stretching, and milestone considerations, is usually completed by a licensed occupational (like myself) or physical therapist. This is a topic and area I am very passionate about and I have devoted my career to helping parents correct their baby’s head conservatively, without the usage of a helmet. This conservative correction, in my professional experience, is best in cases of mild and moderate head shape shifts. Severe head shapes can be corrected conservatively, but if the baby is older than 6 months and no improvements in the head shape have been made through repositioning than helmet therapy may be best option. As an occupational therapist and mom of an infant that had plagiocephaly, I am very passionate about conservative correction without the usage of a helmet and have created a detailed program for repositioning and tension release. Complete this form for a free head shape analysis to see if my program would benefit your baby!

So what about helmet therapy??

You can also fix your baby’s flat head shape through helmet therapy which is where your baby is fitted for a cranial helmet by, usually, a licensed orthotist. This cranial helmet is used to shift the skull place back into place and restore the head shape. This is type of therapy is necessary in some cases, especially if your baby’s flattening is rated “severe.” If your baby has severe flattening, they may required a helmet due to difficulty with repositioning approaches on the targeted areas. A helmet assessment is completed at a orthotics or cranial clinic and includes an evaluation, fitting, and follow up appointments. When being assessed for a cranial helmet, the technician will provide values rating your baby’s head shape severity. The values that I use to guide my judgement are as follows and were provided to me by a trusted helmet orthotist.

If the pediatrician refers your baby to a helmet evaluation, use these values above to guide your decision making.

The duration of the helmet wear schedule is directly related to your baby’s compliance and the changes of their head. The helmet is made to block the areas of growth where the skull mass has been redistributed. These redistributed mass areas are also referred to as the bulging sides. Directly opposite of the bulging areas are concave parts of the helmet. As your baby’s head grows, the head fills in the areas where the helmet is concave, which works to restore the shape. The longest duration, based on information from a trust colleague, of helmet treatment may be up to 4 months when the baby is over the age of 6 months. A second helmet is usually not indicated the majority of the time. There are wear procedures, cleaning instructions, and guidelines that are provided when the helmet is fitted and given to your baby. The helmet works directly opposite of repositioning strategies, where the helmet waits for the head to grow into the helmet and repositioning strategies correct the head already there. Both methods require maintenance of the head shape if the infant continues to sleep on their back after correction.

So what about these other ways to fix flat head?

Other treatments like craniosacral therapy and chiropractic care have been used in fixing flat head shape. These therapies focus on whole body tension and fascia release to encourage the baby to have the flexibility to sleep on the sides of the head that are not flat. Craniosacal therapy consists of specific movements and handling techniques to determine where the tension is located. The therapist then may release that tension through bone mobility, gentle movements, handling, bodywork and/or massage. These methods of treatment and tension release are effective, but a home stretching and tension release program is very important to increased the effectiveness of treatment. A repositioning program should also be implemented in conjunction to these approaches. Craniosacral therapist may also completed a hands-on non-invasive manipulation called “rocking the sutures.” This is when gentle pressure is applied to the sutures of the head to shift the plates back into a normal alignment. This shifting of the plates, as mentioned above, is the reason why the head become noticably flat. There is not a lot of empirical evidenced for this treatment, but there has been some evidence that this appears to be potentially effective.

Chiropractic care can be effective in rounding the head for young babies (birth to 4 months) and in my experience, it is recommended, as well, to couple this care with an at-home stretching and tension release program. A positioning program should also be included as well for more effective head rounding improvements. Chiropractic care can be very effective in reducing whole body tension and reducing bone misalignment which can be affected by tight muscles. Both of these approaches can improve and fix flat head in infants.

All of these methods, repositioning and traditional therapy, helmet therapy, and craniosacral and chiropractic care can be effective in fixing flat head.

These methods all involve either resolving the flattening directly and/or minimizing the whole body tension so the baby can move their head more freely. I, as an occupational therapy and mom, am passionate about getting parents the services they need whether they have had wonderful results with conservative options, tried conservative options and did not have the success they desire, or choose to place their baby in a helmet. All of these ways to fix flat head are very important and at the end of the day, the goal is the have a baby that is able to achieve milestones in a timely manner and has a nice round head. If your baby has developed flattening on their head, do not panic. As quickly as the flattening developed, the flattening can be corrected. If your baby is below the age of 9 months and you are interested in conservative correction, feel free to submit a FREE head shape evaluation here! I would love to help fix your baby’s head and keep them out of a helmet if possible. If your baby’s head shape causes you anxiety or if your pediatrician has mentioned your baby’s head flattening, do not wait to resolve this issue. The correction of the head is much more successful if treated earlier. If your baby does not have flattening and they are below the age of 6 months, or are still sleeping on their back, their head can become flat. Please reach out here to schedule a preventative consultation so we can get you the tools you need to prevent this flattening.

As always, I am always here to help you and your baby. That is my heart and as a mom I have been where you are.

Download our free “flat head” guide here to learn more about preventing & correcting “flat head” with your baby.

Thanks for reading!

Brooke, OTR/L