Flat Head Syndrome in Babies (Plagiocephaly): Causes, Early Signs and How to Help
Plagiocephaly, commonly known as flat head syndrome, occurs when a baby's soft skull develops an area of flattening due to repeated pressure on one part of the head. While common, it should not simply be dismissed as a cosmetic concern. Early intervention, including tummy time, repositioning, movement-based care, and in some cases helmet therapy, can help support healthy skull development. At Nomad Chiropractic, we assess both head shape and the underlying movement patterns that may be contributing to the flattening.
You Notice a Flat Spot… Now What?
Few things create more anxiety for new parents than noticing something doesn't look quite right with their baby's development.
For some families, it's a preference for looking one way. For others, it's a flat spot at the back of the head that seems to be becoming more obvious with each passing week. Sometimes grandparents notice it first. Sometimes it shows up in photos.
One of the most common questions we hear is:
"Will it just round out on its own?"
The answer depends on the baby, the severity of the flattening, and whether there are underlying movement restrictions contributing to the problem.
The good news is that plagiocephaly is common, and there is a lot that can be done to support healthy head shape development when it is identified early.
What is Plagiocephaly?
Plagiocephaly is the medical term used to describe asymmetrical flattening of a baby's skull.
Most commonly, one side of the back of the head becomes flatter than the other. As this occurs, parents may also notice:
One ear sitting slightly further forward
Forehead prominence on one side
Facial asymmetry
A head-turning preference
Difficulty looking equally in both directions
Because a baby's skull is soft and rapidly growing, repeated pressure on the same area can gradually influence its shape.
This is known as positional plagiocephaly and differs from craniosynostosis, a more serious condition involving premature fusion of skull sutures that requires specialist medical assessment.
Why Has Plagiocephaly Become More Common?
Since the introduction of the Back to Sleep campaign, rates of plagiocephaly have increased significantly.
Importantly, safe sleep recommendations should absolutely continue to be followed. Back sleeping remains the safest sleeping position for reducing the risk of SIDS.
However, spending many hours each day resting on the back of the head can increase the likelihood of flattening developing, particularly when combined with other factors such as torticollis or a strong positional preference.
What Causes Plagiocephaly?
In our experience, plagiocephaly is rarely caused by a single factor. More often, it develops through a combination of influences before birth, during birth, and throughout early infancy.
In-Utero Positioning
Some babies spend weeks or months in a position that places pressure on one area of the skull.
This can be more common in:
First pregnancies
Multiple pregnancies
Breech presentations
Limited uterine space
Larger babies
Birth-Related Factors
The birth process places considerable forces through a baby's skull, neck, and body.
While birth is a normal physiological process, factors such as:
Long labours
Fast labours
Assisted deliveries
Posterior positioning
Caesarean birth after labour
may contribute to muscular tension or movement restrictions that influence how a baby moves after birth.
Torticollis
Torticollis refers to tightness in the neck muscles that causes a baby to prefer turning their head one way.
This is one of the most common findings associated with plagiocephaly.
If a baby consistently rests on the same part of their head, flattening often develops over time.
Container Time
Car seats, capsules, swings, bouncers and rockers are wonderful tools for parents, but extended periods in these devices can increase pressure on the back of the skull.
Limited Tummy Time
Tummy time helps develop neck strength, shoulder stability, coordination and postural control.
Babies who struggle with tummy time often spend more time on the back of their head, increasing the opportunity for flattening to occur.
What We Commonly See in Practice
As chiropractors who work with babies every day, plagiocephaly is something we assess regularly.
Often parents arrive feeling worried, guilty, or frustrated that despite their best efforts, their baby's head shape doesn't seem to be improving.
One of the most common things we find is that the flat spot is only part of the story.
Many babies with plagiocephaly also have a strong preference for looking one way, difficulty feeding comfortably on one side, tension through the neck and shoulders, or a noticeable dislike of tummy time.
Sometimes parents tell us:
"I've been trying to get them to look the other way, but they always go straight back."
In our experience, this isn't usually because parents have done something wrong.
More often, it's a reflection of how a baby's body has adapted to life in the womb, their birth experience, or early movement patterns.
One of the most reassuring conversations we have with parents is explaining that plagiocephaly is often highly responsive to early intervention. The younger the baby, the faster the skull is growing and the more opportunity there is to influence healthy development.
How We Measure and Track Plagiocephaly
At Nomad Chiropractic, we don't rely solely on visual observation.
While photos can be helpful, they don't always accurately reflect the degree of asymmetry.
To objectively assess head shape, we use the Mimos Craniometer, a non-invasive measuring tool specifically designed for infant cranial assessments.
These measurements allow us to establish a baseline and monitor changes over time.
We then use a cranial asymmetry calculator to determine measurements such as:
Cranial Vault Asymmetry (CVA)
Cranial Vault Asymmetry Index (CVAI)
These values help us classify the severity of plagiocephaly and monitor progress as care continues.
Parents often find this reassuring because it removes much of the guesswork. Rather than relying on visual impressions alone, we can objectively measure whether improvements are occurring and determine whether further intervention or co-management may be beneficial.
How Chiropractic Care Fits In
One important thing for parents to understand is that plagiocephaly is not simply a skull-shape issue.
The question we ask is:
"Why is this baby spending so much time on that part of their head?"
If a baby has difficulty comfortably turning their head both directions, addressing the flattening alone may not address the underlying cause.
At Nomad Chiropractic, our assessment includes:
Head shape
Neck mobility
Spinal movement
Muscle tension
Feeding preferences
Developmental milestones
Tummy time tolerance
Chiropractic care for babies uses extremely gentle techniques designed to support comfortable movement and function.
Our goal is not to "reshape" the skull directly. Rather, we aim to support balanced movement patterns so babies can more easily move, explore and vary their positions throughout the day.
Home Care Strategies That Can Help
Parents play a crucial role in supporting head shape development.
Prioritise Tummy Time
Aim for frequent, short sessions throughout the day.
Reduce Container Time
Use swings, capsules and bouncers when needed, but maximise floor play and movement opportunities.
Encourage Looking Both Ways
Position toys, family members and interesting objects on the non-preferred side.
Carry Your Baby More Often
Babywearing and upright carrying reduce pressure on the skull while supporting vestibular and motor development.
Alternate Feeding Positions
This encourages babies to rotate their head in both directions throughout the day.
Seek help from a Paediatric Chiropractor!
Removing dural tension, cranial, spinal and peripheral (limbs) tension patterns or subluxations is key.
When Are Helmets Recommended?
Helmet therapy is typically considered for babies with moderate to severe plagiocephaly, particularly when significant asymmetry persists despite conservative management.
Helmet therapy works by guiding skull growth into areas where growth is needed while limiting expansion in more prominent areas.
The optimal window is generally between four and eight months of age, when skull growth is most rapid.
Helmets and Chiropractic: Why Both May Be Important
This is an important distinction that parents are often not told.
A helmet can help guide the shape of the skull.
However, a helmet does not address:
Neck tension
Torticollis
Head-turning preferences
Feeding asymmetries
Movement restrictions - cranial, spinal, peripheral joint restrictions.
In other words, a helmet may influence the shape of the head, but it doesn't necessarily address why the asymmetry developed in the first place. And doesn’t address the brain-body connection (or disconnection)
This is why many babies benefit from a team approach involving helmet providers, chiropractors, osteopaths, paediatricians and parents working together.
The goal is not simply a rounder head shape, but a baby who moves comfortably and symmetrically as they grow.
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As a chiropractor who works with babies every day, plagiocephaly is something we see regularly in practice. Often, parents arrive feeling worried, guilty, or frustrated that despite plenty of tummy time and their best efforts, their baby's head shape isn't improving. What we commonly find is that the flat spot is only part of the story. Many of these babies have a clear preference for looking one way, difficulty feeding on one side, tension through the neck or shoulders, or simply seem more comfortable resting in the same position. One of the most reassuring things I tell parents is that this isn't caused by bad parenting. More often, it's a reflection of how a baby's body has adapted to their position in the womb, the birth process, or early movement patterns. The earlier we can identify these patterns and support more balanced movement, the more opportunity we have to influence healthy head shape development during this important window of growth.
The Nomad Difference
At Nomad Chiropractic, we take a whole-child approach to plagiocephaly.
Rather than focusing solely on the flat spot, we assess the movement patterns, muscle balance, developmental milestones and environmental factors that may be contributing.
We use objective measurements to track progress, provide practical home strategies, collaborate with other health professionals when required, and support families through what can often feel like an overwhelming experience.
Our goal is to help babies move well, develop well and thrive during this important period of growth.
Learn more about how we work:
Frequently Asked Questions about our Chiropractic Care for Headshape Asymmetry
1. At what age is it too late to improve plagiocephaly?
The best opportunity for improvement is during the first year of life, particularly before 4mths, definitely before 12 months… when the skull is growing rapidly. That said, it's never too late to have your baby assessed. Even if head shape changes become less dramatic with age, addressing underlying movement patterns, neck tension, and developmental concerns can still be beneficial.
2. Can plagiocephaly affect my baby's development?
Research has identified associations between plagiocephaly and delays in motor development, likely because many babies with plagiocephaly also have underlying movement restrictions or torticollis. This is why assessing your baby's overall movement and development is just as important as assessing head shape.
3. How do I know if my baby's flat head is severe enough to need a helmet?
The decision is usually based on objective measurements rather than appearance alone. Measurements such as Cranial Vault Asymmetry (CVA) and Cranial Vault Asymmetry Index (CVAI) help classify plagiocephaly as mild, moderate, or severe. A healthcare professional experienced in cranial assessments can help determine whether repositioning strategies are appropriate or whether a helmet assessment should be considered.
4. Can tummy time alone fix plagiocephaly?
Tummy time is one of the most important things parents can do to reduce pressure on the skull and encourage healthy development. The explanation is simple —> getting them off their flat spot! However, if a baby has significant neck tightness, torticollis, or a strong head-turning preference, tummy time alone may not fully address the underlying cause. A comprehensive assessment can help identify additional factors that may need support.
5. What is the difference between plagiocephaly and craniosynostosis?
Plagiocephaly is usually caused by external pressure on a baby's soft skull and is the most common reason for head shape asymmetry. Craniosynostosis is a much rarer condition involving premature fusion of one or more skull sutures and requires prompt medical intervention. Because treatment pathways are very different, any concerns about unusual head shape should be assessed by an appropriately qualified healthcare professional.
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⚠️ Disclaimer:
This information is educational only and is not intended to replace individual medical advice. Chiropractors do not claim to “treat” medical conditions in infants. If you have concerns about your baby’s health or development, please consult your GP, paediatrician, or other qualified health professional. -
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Chiropractic & Neurodevelopment References
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Nomad Chiropractic Resource
Bartlett, L. (2025). A Deeper Dive Into Plagiocephaly (Flat Head Syndrome). Nomad Chiropractic. Retrieved from:
Nomad Chiropractic – A Deeper Dive Into Plagiocephaly (Flat Head Syndrome)
If you're concerned about your baby's head shape, we'd love to help assess their movement, development and cranial symmetry and provide clear guidance on the next steps.
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Gentle, Evidence-Informed Chiropractic Care for Babies in Mosman
Plagiocephaly is common, but it shouldn't be ignored. Early intervention can make a significant difference during the period when a baby's skull is growing most rapidly. Repositioning strategies, tummy time, movement-based care and, in some cases, helmet therapy may all play a role. Addressing both head shape and the underlying movement patterns often provides the most comprehensive approach to supporting healthy development.