Yes, some infants face higher risk of flat head syndrome due to prematurity, neck tightness, multiples, and long stretches on firm surfaces.
Worried about a flat spot on the back or one side of your baby’s head? You’re not alone. The soft skull of a young infant can change shape when pressure rests on one area for long periods. That’s why some newborns and young infants develop a flat area, a pattern doctors call positional plagiocephaly (side flattening) or brachycephaly (back flattening). The good news: for most babies, early tweaks to routine ease the pressure and the head rounds out over time.
Which Babies Have Higher Risk Of A Flat Spot?
Head shape reflects two forces: pressure and movement. Babies who spend long stretches on one surface or have trouble turning their necks are more likely to form a flat area in the first months. Here’s a quick, scan-friendly map of common risk factors and what to watch.
| Risk Factor | Why It Raises Risk | Simple Checks |
|---|---|---|
| Prematurity | Softer skull and longer hospital stays limit free movement. | Was baby born early or in the NICU? |
| Neck Tightness (Torticollis) | Limited head turn keeps pressure on one spot. | Does baby favor one side or tilt? |
| Multiples | Less room before birth; higher chance of early delivery. | Twins or triplets with crowding late in pregnancy? |
| First-Born | Longer labors and more time in carriers or seats are common. | First baby with lots of gear time? |
| Male Sex | Slightly higher rates seen in studies. | Not a cause by itself; adds to the mix. |
| Prolonged Supine Time | Same head spot meets the mattress for many hours. | Long stretches in crib, swing, car seat, or pram? |
| Assisted Delivery | Forceps/vacuum and molding can set an early shape. | Did birth use instruments? |
How Flat Spots Form
An infant skull has several plates joined by sutures. The plates shift a little at birth and during growth. When one area gets steady pressure and the neck turns the same way day after day, bone growth can lag in that region while the opposite side grows forward. That creates the classic look: a flat zone at the back or side, a bit of forehead bossing on the same side, and an ear that looks slightly forward compared with the other ear. This pattern differs from craniosynostosis, a rare condition where a suture fuses too early and needs a separate evaluation.
How To Lower The Risk From Day One
Safe sleep comes first: always place baby on the back for every sleep. That step cuts the risk of sleep-related death and does not cause long-term head shape problems. During awake time, build a rhythm that spreads pressure across different spots and builds neck strength. Here’s a simple plan you can start today.
Daily Care Plan
Tummy Time In Small Sets
Begin with a few minutes several times a day, then add time as your baby tolerates it. Try your chest, a rolled towel under the chest, or a firm mat. Many short sessions beat one long struggle. If the neck is tight, ask your clinician about gentle stretches.
Switch Sides During Feeds And Holds
Alternate the arm you use for bottles and the side used for breastfeeding. When holding or baby-wearing, vary positions so pressure isn’t always on the same area of the skull.
Rotate The View In The Crib
Babies turn toward light and action. Shift the crib position or swap head-to-foot placement on alternate nights so your baby looks left some nights and right on others. Keep the sleep space clear—no pillows, bumpers, or soft toys.
Limit “Container Time” When Awake
Seats, swings, and prams are handy, but long spells keep the head on one spot. Use them for travel and short stints, then switch to floor time, a carrier, or upright holds.
When A Flat Area Is Likely To Appear
Flattening peaks between two and four months, when babies sleep a lot, can’t sit yet, and still prefer one head turn. Once rolling, sitting, and crawling start, pressure spreads out and shape tends to improve on its own. Many mild cases fade by nine to twelve months.
How To Tell Positional Flattening From Other Causes
Most cases need no scans. A pediatric exam usually sorts it out. Signs that point to a different cause include a ridge over a suture, no soft spot, a narrow or unusual head shape that doesn’t match common patterns, or slowed head growth. If any of those show up, ask for prompt assessment because some conditions need imaging and a different plan.
What The Evidence Says About Care
Large reviews and a well-known trial show that early position changes and physical therapy help most babies. Helmet therapy can reshape skulls in selected cases, yet it brings cost, skin irritation, and frequent visits. Many infants improve without a helmet. Care teams weigh head-shape measurements, age, and response to early steps before advising a device.
When To Ask For Physical Therapy
Ask for a referral if your baby always looks one way, hates tummy time, or tilts the head. A therapist can teach home stretches and show positioning tricks. Starting before four months works best.
When To Talk About A Helmet
Some babies with moderate to severe flattening, or babies who start care late, may be candidates. The common start window is around four to six months, with wear for several months. You’ll get measured visits to track change. Many families never need this step; plenty of heads round out with time and simple habits.
Safe Sleep Still Comes First
Back sleeping protects against sudden infant death. Keep using a firm, flat mattress with a fitted sheet and a clear crib. Use tummy time and rotation while awake to share the load on the skull without changing safe sleep steps. For a clear checklist, see the CDC safe sleep guidance. For a plain-language overview of head shape patterns and prevention tips, see AAP HealthyChildren head-shape guidance.
Age-By-Age Guide To Action
Match your baby’s age with practical steps and the right moment to seek help if shape is not improving.
| Age | What To Do At Home | When To Seek Care |
|---|---|---|
| 0–2 months | Back for sleep; start brief tummy time daily; vary holds and feeding sides. | Newborn with very limited neck turn or a marked tilt. |
| 2–4 months | Increase tummy time; rotate crib view; reduce long seat time. | Flat area growing or baby always turns one way; ask for therapy. |
| 4–6 months | Keep the routine; track photos month to month. | Moderate or severe flattening despite steps; discuss helmet timing. |
| 6–9 months | More sitting and crawling will help. | Little or no change from earlier months; seek a head-shape clinic. |
| 9–12 months | Most mild cases fade by this stage. | Ongoing marked asymmetry or concerns about head growth. |
Proof Points From Trusted Sources
Pediatric groups note that most position-related head-shape changes are cosmetic and tend to improve with time and simple steps. Reviews and cohort studies list common risk factors such as prematurity, twins, neck tightness, instrument-assisted delivery, and first-born status. A randomized trial in five- to six-month-old infants reported no clear edge for helmets over the natural course in moderate cases, while other studies show benefit in selected situations with careful fitting and follow-up. The shared theme: start with safe sleep, frequent position changes, and early therapy when neck tightness is present; consider a helmet only when those steps don’t shift the curve.
Practical Checks You Can Do Today
Photo Angle
Take a photo from above while baby is awake and calm. Repeat a month later under similar light. Small gains are easier to see side by side.
Neck Turn
Watch how far your baby turns left and right during play. If one side looks tight or your baby fusses with that turn, ask for stretches and therapy tips.
Gear Audit
List daily awake time in seats, swings, prams, and carriers. Nudge more minutes to floor play and chest carries. Small changes add up across a week.
When To Seek Help Fast
Call your clinician soon if you see a raised ridge on the skull, a missing soft spot, swollen veins, poor feeding, sluggish behavior, or vomiting with a fast-growing head. Those signs point away from simple position-related change.
Bottom Line For Tired Parents
Some babies are more likely to develop a flat area because of early birth, neck tightness, multiples, or lots of time on one spot. The plan is simple: keep sleep safe on the back, pour in short tummy time sessions, switch sides during feeds and holds, rotate the crib view, and trim long spells in seats when awake. If shape isn’t trending better by three to four months, ask for a therapy referral. If flattening is moderate to severe after early steps, talk with your clinician about helmet pros and costs, and make a plan that fits your baby’s age and head measurements.
Method note: This guide draws on pediatric society advice and peer-reviewed studies and reflects the best available evidence at the time of writing.