Positional Head Flattening In Babies

Key points about positional head flattening in babies

• positional head flattening may happen if a baby lies with their head in the same position for a long time
• you can help to prevent a flat spot from occurring by varying your baby's head position when you put your baby to bed
• always sleep your baby on their back, but from birth, try to turn their head to a different side at each sleep

What is positional head flattening in babies?

Positional head flattening is sometimes referred to as flat head in pēpi (babies). Its medical name is positional plagiocephaly.

It happens because the bones of a young baby's head are thin and flexible, so can change shape easily.

Positional head flattening may happen if a baby lies with their head in the same position for a long time.

Sometimes pēpi are born with a slightly flat spot on their head. They may have head swelling or bruising from a difficult birth. These pēpi may be more at risk of developing a flat head.

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• The image is a medical-style illustration showing a baby’s head from above.
• The baby’s arms are bent, with fists up near the head.
• The head is rounded and symmetrical on both sides.
• Two dashed green lines run horizontally—one across the forehead and one across the back of the head—indicating an even, balanced shape.
• Text beneath the image reads: "Normal".
• Branding at the top left corner reads KidsHealth Hauora Taitamariki with the website: kidshealth.org.nz.
• The initials “GF” are visible on the baby’s left arm (artist signature).

transcribeTranscript expand_more expand_less

• The image is a medical-style illustration showing a baby’s head from above.
• The baby’s arms are bent, with fists up near the head.
• The head shows a visible flattening on the left back side, creating an asymmetrical head shape.
• Dashed green lines again outline the front and back of the head, but this time they highlight the uneven contours—indicating a flat spot on the left rear side.
• Text underneath the image reads: "Positional head flattening".
• Branding at the top left corner reads KidsHealth Hauora Taitamariki with the website: kidshealth.org.nz.
• The initials “GF” are visible on the baby’s left arm (artist signature).

If my baby has a flat head, will it improve?

Research in Aotearoa New Zealand has shown that most pēpi with positional head flattening will improve over time. But, it is best to prevent it happening in the first place.

Preventing positional head flattening

You can help to prevent a flat spot from occurring by varying your baby's head position when you put your baby to bed.

Always sleep your baby on their back, but from birth, try to turn their head to a different side at each sleep. Don't use pillows in the cot for positioning.

Head and cot position

Change your baby's head position each time you put them down to sleep.

Place your baby at different ends of the cot at each sleep, or change the position of the cot in the room, so that you come to their cot from different sides.

Pēpi often like to look at fixed objects like windows or wall murals, so changing their cot position will encourage them to look at things that interest them from different angles.

Play time

When your baby is awake and alert:

• play or interact with them facing you (face time) or
• place them lying down on their front (tummy time) or on their side from as early as one or 2 weeks of age

Place rattles or toys (or other people's faces) that your baby likes to look at in different positions. This encourages your baby to turn their head both ways. Even at 2 weeks of age, your baby can follow your voice or eyes (keep eye contact). They can turn their head themselves each way if you support their head in your hands while they are awake and alert.

Vary the way you hold and carry your baby

Avoid having your baby lying down too much by varying their position throughout the day. You could:

• use a sling
• hold them upright for cuddles
• carry them over your arm, on their tummy or side

When to get medical help for your baby with positional head flattening

If your baby does develop a flat head, discuss it with your lead maternity carer, Well Child provider or family doctor.

Occasionally there may be another reason for your baby's flat head.

Tight neck muscle

A tight neck muscle (torticollis) on one side can prevent your baby from turning their head the other way. The muscle is called the sternoclenomastoid muscle. If your baby has this problem, your doctor may send you to a physiotherapist.

A problem with cranial sutures

A very rare cause of a flat head in pēpi is a problem with their cranial sutures (craniosynostosis). If you are concerned about an unusual head shape, check with your doctor.