Flat head syndrome is on the rise in children: How parents can help prevent it

  • Tummy time early and often is key to preventing flat head syndrome in babies.

    Tummy time early and often is key to preventing flat head syndrome in babies. Getty Images

Dr. Frank Vicari
Advocate Children’s Hospital
Posted9/8/2019 7:00 AM

Plagiocephaly, or flat head syndrome, is a common condition that research has shown affects nearly 30 percent of babies by the time they see a doctor for their 2-month well-child visit.

Factors that can cause and contribute to plagiocephaly include premature birth, multiple births, position in the womb, use of extended time in car seats, swings and bouncy seats, lack of tummy time, sleep position, and torticollis, which is a condition commonly associated with plagiocephaly.


Torticollis is a condition in which the muscles that control neck extension, rotation and tilt are weak or tight. Torticollis limits the baby's ability to turn toward the affected side, causing them to consistently hold their head in one position. Over time, the one-sided positioning can flatten one side of the head.

The environment kids are growing up in today -- spending more time in car seats, swings, exersaucers -- is contributing to higher incidence of plagiocephaly because infants have little opportunity to strengthen their head and neck muscles.

Infants sleep 10 to 14 hours a day plus naptime, so there are very few hours to work on normal neck strengthening processes, which leads to prolonged supine positioning.

This is why engaging in tummy time, which helps strengthen head and neck muscles, is so important. If their neck is weak, stiff, and they are always supine, there will be a strong tendency for them to get a flat head, also known as positional molding.

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Plagiocephaly and torticollis are treatable, especially when intervention starts early.

About 70 percent of infants who develop plagiocephaly can be successfully treated by conservative measures. Roughly 30 percent of infants who develop plagiocephaly could be candidates for cranial orthosis, or helmet therapy.

When necessary, a 1.5-second scan is performed to take measurements for the child's custom-made helmet. Children wear the helmet 23 hours a day, seven days a week until their head shape grows into the mold of the helmet and is no longer misshapen.

Infants are usually fitted for a helmet between 3 and 5 months of age and typically wear it for several months. The time when a helmet can be most effective depends upon the age of the child and severity of the deformity.

It should be stressed that practicing tummy time early and often is key to preventing plagiocephaly. Parents are often apprehensive to start tummy time because they worry the baby is fragile or not ready, but babies are born ready to practice.


Tummy time should start the day a child is taken home from the hospital, which means parents need to know how to do tummy time with their newborn child.

Parents should ask their pediatricians or seek the advice of a pediatric physical therapist if they have concerns.

Families can practice tummy time with infants during every awake time, even if just for a minute or two. Frequency of tummy time throughout the day is more important than the intensity.

Additionally, try to limit prolonged time in car seats, reclined positioners, standing devices, and baby walkers. Most importantly, don't delay in seeking help if you think something is wrong.

If parents are concerned about their baby's head shape and are considering therapy and a cranial orthosis, there is a window of opportunity to make the decision regarding a cranial orthotic. To reiterate, this is typically between 4 and 6 months of age, but depends upon the severity of the problem and the baby's age.

• Children's health is a continuing series. This week's article is courtesy of Dr. Frank Vicari, chief of pediatric plastic surgery/craniofacial surgery and director of the Head Shape Evaluation Program at Advocate Children's Hospital.

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