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In most cases a baby has an oval shaped head. The right and left sides appear to be the same.

A baby with ‘positional plagiocephaly’ has a flat spot on the back or side of the head. It is caused by pressure against the very soft bones of the baby’s head. This happens when a baby lies in one position most of the time. This is usually seen in the first 3-6 months of life. Sometimes the baby can be born with it.

The bones and the areas in between the bones (called ‘sutures’) are soft so the baby can move through the birth canal. This softness lasts for the first two years of life to allow for rapid brain growth.

Positional plagiocephaly does not affect a baby’s brain growth or cause brain damage.

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Diagnosis

Sometimes positional plagiocephaly looks like a more serious condition called ‘craniosynostosis.’ The ear, near the flat spot, is shifted forward on most babies. The diagnosis is made by our doctors in the clinic with an exam of the baby’s head. There is no need for X-Ray, CT, or MRI.

Causes

It is safest for babies to sleep on their backs, this can result in a flat spot on the back of the head. Healthy babies should always be placed on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS). 

Some babies will look in one direction due to limited range of motion in the neck (torticollis). This is common and almost always goes away by itself. Physical therapy may be needed in some cases.

Once your baby is able to sit and stand, the pressure on the head bones is reduced. The head shape begins to improve. The flattening does not show as much as your baby gets older. Thicker skin will develop and hair will grow.

Treatment

The most important treatment is to change the position of your baby’s head. Most cases self-correct.

  • Try to keep your baby off the flat portion of the head.

  • While you are watching and playing with your baby, have active 'tummy time.' Tummy time helps your baby’s head, neck, and shoulder muscles get stronger.

  • Urge crawling, rolling, reaching, pushing, pulling, holding, and grasping.

  • Choose other ways for your baby to be held.

  • Babies need a lot of time sitting in laps, cuddling, playing, and chances to move.

  • Avoid long periods of time with your baby in the same position (as in car seats, strollers, infant seats, cribs, and playpens). 

  • Every few days change the position your baby is lying in the crib. 

  • Change the location of your baby’s crib so that he or she has to look in different ways to see the door or the window. Babies tend to want to turn toward noise, music, light, people, etc. 

  • A rolled up towel behind your baby’s back will help to reduce pressure on the flattest part of the head. Do not put the towel under the head, as this could make it worse. Another option is a set of two rolls that are velcroid together to prevent the baby from rolling off them. You can find these at baby stores.

  • If your baby has torticollis a physical therapist can teach you exercises that can help.

  • Very gently turn your baby’s head in each direction with every diaper change.