Flat Head- Plagiocephaly and Brachycephaly

“My baby has a flat head” is one of the most common statements mentioned to me when treating paediatric patients. It is usually something the parents have noticed themselves, or it has been mentioned by a health professional or family/friends. 


A baby’s skull is very flexible and mouldable due to the presence of fontanelles (soft spot). The anterior fontanelle is located at the front of a baby’s skull and there is also a smaller one at the back of the skull. For more information about the soft spots on a baby’s head check out our blog post on fontanelles.

It can be very common for babies to have an unusual head shape when born, particularly a cone shape. This is usually due to the baby’s position inside the uterus or as a result of the moulding from labour. With time, most head shapes should return to normal.

Flattening of the head in one area is known as plagiocephaly. A baby who has a preference to only look one way, may develop a misshapen or flat head on that same side. These babies usually have limited neck rotation one way, and this topic will be explored in one of our other blog posts. A flat spot on the back of a baby’s skull is known as brachycephaly. 

Plagiocephaly does not affect the development of the brain, but it can lead to alterations in physical appearance of the skull and facial features. You may also note that the area may have a balding patch in the hair. 

A baby must be placed on their back for sleep to prevent sudden infant death syndrome (SIDS) and pillows or other items must not be used for positioning in the cot. Read on for some tips to prevent and manage flat spots.


  1. Allow a lot of opportunities for tummy time during the day. The more a baby enjoys tummy time, the more time they are off lying on their back. Check out our blog,‘Tips and Trick for Tummy Time’ for some ideas.
  2. Encourage babies to look both ways in awake time. Use things they like to look at such as mirrors, windows or your face to entice them to turn the other way.
  3. Very gently alternate the baby’s head position, if they let you, when they are asleep. 
  4. Alternate the end of the cot that the baby sleeps in or change the position of the cot in the room. This will encourage your baby to look the other way to observe things of interest.
  5. Vary holding and carrying positions of your baby. This will help reduce the pressure placed on the back of their skulls. It will also encourage them to look at objects from different angles.
  6. Have a lot of one on one interaction time with baby. Plenty of eye contact is encouraged.


In most cases with time, natural neck strength improvements and encouraging your baby to have full neck range of motion, the flat spot should resolve. 

In addition paediatric manual therapy has been seen to aid in the management of plagiocephaly.[1]

The use of helmet therapy for plagiocephaly is uncommon, and if required babies are fitted with a lightweight helmet to wear for varying hours throughout the day.

If you are worried about the shape of your baby’s head, please mention it to a health professional.

Dr. Simmone Ortland (osteopath) at Total Balance Healthcare

This blog post is an educational tool only.  It is not a replacement for medical advice from a registered and qualified doctor or health professional.

Any other questions not answered here? Get in touch with us! Phone:  (03) 97738085

References and Resources:

    1. Cabrera-Martos, I., Valenza, M.C., Valenza-Demet, G. et al. Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study. Childs Nerv Syst 32, 2211–2217 (2016). https://doi.org/10.1007/s00381-016-3200-5
    2. The Royal Children’s Hospital (https://www.rch.org.au/kidsinfo/)
    3. Raising Children (https://raisingchildren.net.au)
    4. Red Nose (https://rednose.org.au/section/safe-sleeping

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