Babies with positional plagiocephaly (play-jee-oh-SEF-uh-lee) have a flat spot on the back or side of their head. This usually happens because the baby keeps their head turned to the same side while sleeping and sitting in a car seat, stroller, or bouncy seat. The baby may also have weak or tight neck muscles. With frequent changes to the position of the head and strengthening exercises, the flattening usually gets better within a few months. Follow these instructions to care for your baby.

Safety Reminder

Always put your baby to sleep on their back, face up in the crib. Never put them to sleep on their belly or side, because this increases the risk of crib death (SIDS, sudden infant death syndrome). An older baby may roll on their side or belly during the night and that's OK.

Keep Your Baby's Head Off the Flat Spot

• When your baby is in the crib or in a car seat, stroller, or bouncy seat, gently turn their head so it is not resting on the flat spot. They may move it back, but it still helps your baby develop their muscles.
• When changing your baby's diaper, feeding them, and talking/playing with them, position yourself so they turn away from the flat spot to look at you.
• When you put your baby in the crib, place them so they must turn away from the flat spot to see you when you are in the room.
• Pick your baby up often. Limit their time in the car seat, stroller, or bouncy seat.
• Don't use any pillows, wedges, rolled-up blankets, or positioners to change your baby's position. Even the ones advertised to help with flat spots have not been shown to help, and any of these could come loose and be dangerous to your baby.

Exercises

• Follow your health care provider's recommendations for:
  • strengthening and stretching exercises
  • whether your baby should go to physical therapy
  • whether your baby should see a specialist (such as an orthopedic doctor)
• Give your baby "tummy time" when they're awake and someone is watching. Never leave your baby alone during tummy time. Here's how to do it:
  • Place your baby on the floor on their stomach.
  • Talk or play with them so they lift their head.
  • Start with just a few minutes at a time and work up to an hour a day (divided into 10- to 15-minute sessions).
• Hold your baby in a way that encourages them to use their neck muscles:
  • Lie down and put your baby on your chest so they need to lift their head up to look at you. Never fall asleep holding your baby on your chest. They could roll off and get hurt.
  • Switch arms each time you hold or feed your baby so they turn their head in both directions.

• Your baby can't move their head in both directions.
• The flattening doesn't seem to be getting better within about a month or seems to be getting worse.

What causes a flat spot in babies? An infant's skull bones are soft and not yet fused together (this is why a baby can pass through the birth canal during childbirth). This lets the brain grow, but it also can lead to a flat spot if the baby:

• often sleeps and sits with their head turned a certain way
• spends too much time lying down and doesn't develop their neck muscles
• has torticollis (tight neck muscles)

What happens if exercises and changing a baby's head position don't help the flat spot? If these treatments don't help by the time a baby is 5 or 6 months old, a special helmet can be made for the baby. Over time, it slowly reshapes the baby's head.

Does a flat spot affect a baby's brain? No, a flat spot does not limit a baby's brain growth or cause any kind of brain damage.