Identifying Flat Head Syndrome Types in Infants

Flat head syndrome shows up as an irregularity at the back or side of the head. Parents often notice it around eight weeks: a slightly wider head, one ear pushed forward, or a more prominent brow. Depending on the type, the head may look asymmetric or uneven. Families sometimes search for “flat head in babies,” but the clinical term is flat head syndrome (positional plagiocephaly and related patterns).

An infant’s cranial sutures do not fully fuse until later childhood, so the bones remain soft and can change shape—especially when a newborn lies in one position for long periods. Pressure in the womb or early engagement in the birth canal can also flatten areas of the skull before birth.

For a fuller overview, see our article on what flat head syndrome is.

Types of Flat Head Syndrome

Different patterns appear depending on where pressure is applied and how the head responds.

There are four main categories parents often use when identifying head shape:

• Plagiocephaly

The most common pattern. Families often say, “one side of my baby’s head is flat.” Flattening is usually at the back-side of the head and looks asymmetric from above. An ear may be out of alignment, and the cheek and brow on the flat side can look pushed forward.

• Brachycephaly

Parents often ask, “the back of my baby’s head is flat—what does that mean?” This usually points to a brachycephalic pattern: a wide head that is very flat across the back, sometimes with a steep occiput and a more prominent forehead.

• Scaphocephaly

A long, narrow head shape, sometimes called dolichocephaly. Parents may also notice that the ears do not line up evenly.

• Normocephaly

A typical head shape, often described as a width about 78–83% of length and diagonal asymmetry under 6 mm. From above it may resemble an egg shape and is considered within normal range.

Babies are often brought with a combination of brachycephaly and plagiocephaly; sometimes scaphocephaly and plagiocephaly appear together. That does not mean two separate syndromes—it describes where flattening sits. Some writers group these under one “flat head” umbrella, but for treatment planning it matters where growth should be allowed. At CranioWell we measure each head so we know where guided growth is needed.

For more detail on patterns, see our overview of types of flat head syndrome.

Craniosynostosis is a different condition sometimes confused with positional flattening. Read more in our craniosynostosis article.

What Causes Flat Head Syndrome?

Common contributing factors include:

1. Limited tummy time

Supervised tummy time helps balance the long hours babies spend on their backs while awake. If tummy time is rarely offered, flattening can progress. Always stay with your baby during tummy time.

2. Pressure in the womb and during birth

Pressure on the soft skull before birth is a common contributor, especially in multiple pregnancies when space is limited. Forceps or vacuum assistance during delivery can also contribute in some cases.

3. Premature birth

Premature infants often have softer bones and may be less able to move the head early on, increasing risk of positional flattening.

4. Torticollis

Torticollis (wry neck) means neck stiffness that limits turning and can tilt the head. Limited motion plus pressure on one side can lead to flat head patterns.

5. Sleep position

Since the Back to Sleep campaign in the 1990s, infants have been placed on their backs to reduce SIDS risk—a life-saving recommendation. Always place your baby on the back for sleep, and when awake and supervised, use tummy time and repositioning.

Preventing Flat Head Syndrome

There are many ways to reduce risk while your baby is young. Some clinicians say mild flattening will improve on its own; research still suggests that a portion of children with more severe patterns at age two may continue to show noticeable asymmetry later. Early, practical habits help. See also our notes on preventing flat head patterns.

Tips to Reduce Risk

1. Repositioning

When bones are still soft, changing head position during sleep and awake time can limit worsening. Follow safe sleep rules while alternating orientation.

2. Plenty of tummy time

Make supervised tummy time a regular part of the day. Our tummy time guide has practical tips.

3. Simple holding changes

Limit long stretches in car seats and vary feeding holds so the back of the head is not under constant external pressure.

4. Exercises for torticollis

If your baby has torticollis, ask a clinician or therapist before starting stretches at home.

Later Concerns

Practical issues such as difficulty fitting standard sports helmets, and social or emotional concerns about head shape, can appear as children grow—especially if asymmetry remains more noticeable. Addressing significant flattening earlier can help reduce those later worries.

Treatment of Flat Head Syndrome

If repositioning and prevention steps are not enough, or flattening is progressing, cranial remolding helmet therapy may help.

For many babies between about 4 and 14 months, custom cranial helmet therapy can be considered. These helmets are made to guide growth and reduce the severity of the shape difference. Fitting is provided only at CranioWell Orthotics & Prosthetics Centers.

Helmet remolding is generally discussed before about 14 months, when cranial bones are still more malleable.

Is Helmet Therapy Always Needed?

Mild to moderate patterns often improve with preventive techniques. More advanced cases are less likely to improve with repositioning alone. If head shape is not improving by about five months, a clinical assessment can clarify whether extra support is appropriate.

Earlier appropriate care often means a smoother course. Starting while the baby is still young is usually preferred when treatment is indicated.

Whether to continue with helmet therapy is not something families should decide from photos alone. You can contact our clinic for an assessment of severity and a clinician discussion before any decision. 0312 283 26 91