Johns Hopkins All Children's Hospital Patient and Family Resources

Understanding Flat Head Syndrome

The shape of an infant’s head is a common concern of families, but can often be avoided or treated. Find causes of head flattening and tips to prevent it. Flattening of the head is becoming increasingly common in newborns since parents and caregivers are advised to lie infants on their backs to sleep, the safest and only recommended sleeping position. Since a newborn's skull is very soft in the first year of life, it is not unusual for babies to end up with a flat spot on their head. The good news is, a flat spot resulting in baby resting his or her head in the same position for prolonged periods of time is often very treatable.

Positional Plagiocephaly (Flat Head Syndrome)

Positional plagiocephaly can be a result of a baby resting his or her head in the same position for long periods of time. It is usually noticed between two and four months. Positional plagiocephaly will likely get better on its own and repositioning can help. If it does not resolve on its own, helmet therapy may be an option for some families. Check with your child's pediatrician if you feel your baby might need helmet therapy. 

Symptoms of Positional Plagiocephaly

  • Flatness on one side of the back of the head (can be mild or very easy to see)
  • The forehead or face can also be uneven

Parents who notice a flat spot on their baby's head should discuss the concern with their pediatrician


Torticollis is a tightening of a child's neck muscles, which causes the head to tilt to one side and turn to the other side. This can make it difficult for the child to turn his or her head for visual tracking, hold their head in an upright position and perform appropriate upper extremity movements necessary for feeding and play. It can also be associated with positional plagiocephaly.

If not treated, children with torticollis can end up with plagiocephaly, a fairly permanent head tilt, as well as flattening or asymmetry of the skull. For children with torticollis, prompt diagnosis is key since treatment is most effective in a young baby. The good news is torticollis can be resolved with timely physical therapy treatment.

Symptoms of Torticollis

  • Titling of child’s head to one side
  • Difficulty bringing chin to chest
  • Firm small mass on the neck muscle
  • Difficulty turning head to follow movement with eyes
  • Frustration when trying to turn head completely

Parents who are concerned about tightening of their child's neck muscles should discuss the concern with their pediatrician

Ways to Prevent Positional Plagiocephaly and Torticollis

Parents and caregivers should change the baby’s position often when the baby is awake and avoid:

  • Leaving infants in one position for long periods with the infant’s head turned to only one side.
  • Letting the baby sleep or rest in a car seat, bouncy seat, swing or stroller for much of the day.

5 Tips to Help with Tummy Time

Supervised tummy time is a great way to get baby off the back of his or her head. It can also strengthen the baby’s neck, arms, back and tummy muscles. Some helpful tips include:

  1. Try tummy time in short increments.
  2. Recline in a chair or lay on your back and place baby on your stomach while singing or talking to him or her.
  3. Let baby practice holding his or her head up while resting on an inclined surface like a pillow or rolled up blanket.
  4. Cradle baby in your arms, tummy down, and walk through your house or yard and talk to baby about all the things you see.
  5. Place baby on his or her tummy and put a favorite toy within reach to let baby grab at the toy and play.