Positional Plagiocephaly: What to do if your baby's head has a flat spot

What to do if baby has a flat spot forming on his head. CanDoKiddo.com

This is Part 3 in our Positional Plagiocephaly series. Be sure to read Part 1: Why Flat Heads Matter and Part 2: Is My Baby's Head Flat?

We've looked at how head shape can be an indication of how your baby moves and explored how to check your infant's head shape for flattening. But what can you do if you notice a flat spot? Is your baby headed for a helmet? Here are 5 things to do if you notice your baby's head has a flat spot or irregular shape. 

avoiding baby helmet plagiocephaly flat head

1. Get a referral for an OT or PT evaluation: 

If your baby is close to or older than 2 months old, ask your pediatrician for a referral to an Occupational or Physical Therapist who can:

  • Evaluate for Torticollis (neck tightness) and trunk asymmetries
  • Evaluate overall motor development
  • Help you understand how baby gear affects development and help you select the best equipment for your kiddo
  • Suggest ways to play with your little one, position her and adjust your daily routines to minimize pressure in the area of flattening

This isn't a recommendation you'll hear most other places - but I firmly believe that we can reduce the incidence of Flat Head Syndrome and its secondary motor and sensory effects through early detection and treatment. The baby helmet (cranial band or cranial orthotic) is NOT the only treatment.  Try to find a pediatric therapist. Preferably with experience or advanced training in Torticollis and Plagiocephaly (neck and head shape issues of infancy). Ideally with experience in Myofascial Release. But find what you can, given your geography and insurance parameters. Don't panic and go all Web MD and Dr. Google bonkers - I know as new parents, that's our inclination. Odds are that if there is any Torticollis, trunk asymmetry or motor issues that they're minor and very treatable with therapy. But the sooner the better, so don't settle for a "wait and see" approach. 

2. Reduce time in Baby Holding Devices:

If you've read this blog for long, you knew this one was coming. Over-use of baby gear such as infant car seat carriers, baby swings, rock 'n plays, napping wedges and more is a huge contributing factor to positional plagiocephaly (the fancy term for head flattening). 

  • Increase your baby wearing and leave the car seat carrier in the car
  • Don't let baby sleep in swings, bouncy seats, rock 'n plays, napping wedges, lounge pillows, etc. Not only does this contribute to head flattening and neck issues, it increases the risk of SIDS and the American Academy of Pediatrics warns against it.
  • Follow the Rule of 2 and 15

3. Switch Things Up :

avoiding flat head baby helmet plagiocephaly

Most parents fall into habitual ways of doing things with baby. But shaking up these habits can help your little one vary her head position throughout the day. Switch the direction of the pad on your changing table (warning: changing with your non-dominant hand when sleep-deprived will feel like an IQ test that you're not doing well on). That way, when your little one gazes up at you during diaper changes, she's varying the side of the head that gets pressure placed on it. Switch the direction your baby lays in her crib since often babies fall asleep while looking at a preferred object in the room. For bottle-feeding, make sure to alternate which side you hold baby on. These small changes in position add up and can make a big difference in the shape of your infant's head.

4. Play With A Purpose:

Notice your baby's preferred head position when on her back, on her belly and when semi-reclined in Baby Holding Devices. The easiest way to do this is to take a BUNCH of photographs and then look at those to detect any patterns. Early on, we noticed Rowan preferred to look left in Tummy Time and look left in his car seat. So what do you do if you notice a preferred head position?

avoiding flat head syndrome baby helmet plagiocephaly

Use toys and play to encourage your baby to look in all directions when in various positions. We put toys, mirrors, books and people on Rowan's right and within 2 weeks the preference was gone. This easily could have led to a flat spot if it had gone unnoticed. But, through play we encouraged him to stretch and strengthen out of his preferred position and the only Baby Holding Device we had was a convertible car seat that remained in the car.

Does your kiddo always look left in the car? Hang a toy on the right side of her car seat. Position the hanging toys on one side of her activity gym. Or position the whole activity gym to the side of the baby to encourage head-turning. A stargazing box can easily be made with lights only on one side to encourage head turning. Look at books slightly off-center in the direction she doesn't turn as much. Lay baby on her side to play with the flat side of her head up. 

5. Let Go of Guilt:

Repeat after me: "I am not a terrible parent. I love and care for my baby every day. I am learning and growing in this journey and my child is better off for it. My child is going to be fine." And then repeat that several more times today. And again tomorrow. Wallowing in guilt and self-blame doesn't help you or your child. You have new knowledge that you can put into practice starting today that will help your child. Focus on that. 


In summary, if you notice head flattening - don't panic, beat yourself up or resign yourself to spending thousands of dollars on a baby helmet. Get some help to get to the root of why your baby's head is flattening, make some changes in your baby's daily routines, positions and play activities and give yourself a break! 

creative play baby activity book.jpg

Looking for more ideas of ways to play with your little one to prevent or manage head flattening? Check out my book "Begin With A Blanket: Creative Play Ideas for Baby's First 4 Months" - now available in print or eBook in our CanDo Kiddo shop.