Does your baby’s head seem to look flat? You’re not alone. Flat spots are common in young babies and often improve with time and simple daily habits. The most frequent cause is positional plagiocephaly, which means a flat area develops where the skull rests repeatedly on the same spot. When the flattening is mainly across the back of the head, it’s often called brachycephaly.
What is Positional Plagiocephaly?
Babies are born with soft, malleable skull bones that allow for growth. If a baby spends lots of time with their head resting in one position, the pressure can shape the skull, creating a flat area on one side (plagiocephaly) or at the back (brachycephaly).
This is separate from medical conditions affecting the skull bones. It’s also compatible with safe sleep guidance—babies should still be placed on their backs for every sleep on a firm, flat surface with no pillows or loose bedding.
Why It Happens (& Risk Factors)
A mix of everyday factors can contribute:
- Back-lying time adds up: Babies sleep many hours on their backs (as they should), then spend more time flat in prams, car seats, bouncers and swings.
- Neck preference or torticollis: Some babies naturally turn their head to the same side, or have tight neck muscles, making it hard to look the other way.
- Prematurity and multiples: Softer skull bones and higher time spent lying down can increase the chance of a flat spot.
- Limited tummy time: Without regular awake, supervised tummy time, babies miss chances to relieve pressure on the back of the head.
- Reflux-related positioning: Even when upright, babies might still rest their heads against a surface in the same spot.
- Environmental habits: The cot might face a window or door on one side, drawing your baby’s gaze the same way each time.
None of these mean you’ve done anything wrong, they’re simply part of real life with a newborn.
Signs & What to Look For
- One-sided flattening: From above, one side of the back of the head looks flatter; you may notice forehead prominence or a slight ear shift on the same side.
- Back-of-head flattening: The centre back of the head looks wider and flatter (brachycephaly).
- Head-turn preference: Your baby consistently looks to one side and dislikes turning the other way.
- Top-down check: Take a top-down photo (same angle, gentle light) every 2–3 weeks to track changes. A small hand mirror can help with quick daily checks.
If you’re unsure what you’re seeing, raise it at your next health visit.
Safe Sleep Comes First
Keep safe sleep as your non-negotiable:
- Always back to sleep on a firm, flat surface (cot or bassinet that meets AU/NZ standards).
- No pillows, wedges, rolled towels or positioners in the cot.
- Alternate the cot end each night (place baby’s head at alternating ends of the cot) so their view changes and they naturally look different ways.
- Keep the cot clear. This means no soft toys, bumpers or loose bedding.
Tummy Time
Tummy time is a gentle, effective way to take pressure off the back of the head and build neck and shoulder strength:
- Start small, repeat often: Think short, frequent bursts – 30–60 seconds at a time, several times a day, and build up.
- Make it cosy: Try tummy time on your chest, across your forearm or lap, over a rolled towel under the chest, or on a playmat.
- Keep it fun: Use a mirror, high-contrast toys, or face-to-face chat to keep your baby engaged.
- Mini routine: Add tummy time after most nappy changes to create an easy habit.
If your baby protests, try a different angle or surface, or shorten the session and try again later.
Daytime Positioning Tips (Counter-Positioning)
Small tweaks during awake time make a big difference:
- Vary your holds: Use upright babywearing, the football hold, or tummy-down across your forearm (supervised) to reduce pressure on one spot.
- Limit “container time”: Rotate between floor play, tummy time, cuddles and pram walks; avoid long stretches in bouncers or swings.
- Change the view: In the pram or on the playmat, place interesting things (you, a window, toys) to your baby’s non-preferred side.
- Side-lying play: Supervised side-lying on the rounder side encourages turning the head away from the flat spot.
- Alternate arms: Swap feeding arms and change-table positions so your baby naturally looks both ways.
What if My Baby Prefers One Side?
A gentle preference is common. If your baby struggles to turn to one side or seems stiff, speak with your GP/child health nurse. A paediatric physiotherapist can assess for torticollis (tight neck muscles) and provide stretches, positioning ideas and feeding tweaks that fit your baby’s age and routine. Early advice often makes daily care easier.
When Will It Improve?
Many flat spots improve as your baby gains head control, starts rolling and spends more time upright or moving freely:
- With consistent positioning and tummy time, some families see changes in weeks to months.
- Improvement is often gradual. Photos can help you notice small wins.
- The earlier you begin varied positioning, the quicker you may see progress.
Do Some Babies Need Helmets?
A small number of babies with moderate to severe flattening (or those seen later when skull growth slows) may be assessed for an orthotic helmet. This is a specialist decision after careful measurement. Helmets are not needed for most babies. Your GP/paediatrician/physio will guide you on timing, suitability and referrals if required.
Gentle Daily Plan
Here’s a simple, repeatable plan you can pin to the fridge:
- Tummy time: Aim for 3–5 sessions spread through the day; start short and build.
- Swap cot end nightly: Encourage different head turns while keeping safe sleep.
- Alternate arms/holds: Switch sides for feeds and cuddles; vary carrying positions.
- Plan floor time morning & afternoon: Short, frequent, supervised play on a firm surface.
- Prompt head turns: Place toys or sit on your baby’s non-preferred side for eye contact.
- Share the plan: Ask caregivers and grandparents to follow the same routine.
When to Seek Medical Advice
Book a check if you notice:
- Worsening flattening after 2–4 weeks of consistent positioning.
- Obvious neck stiffness or difficulty turning comfortably both ways.
- Concerns about feeding on one side only, or pronounced asymmetry of the forehead/ears/face.
- Any worries about development, or if your instincts say something isn’t right.
Final Thoughts
Flat spots are common, understandable and often reversible with simple, everyday changes. Keep safe sleep as your foundation, add frequent tummy time, and vary positions during awake time. If you’re concerned, seek guidance early. Small changes now can support head shape and comfort as your baby grows.
Helpful Resources from Infants’ Friend
- Settling after feeds? Try ways to relieve trapped wind and learn how to burp a baby.
- Curious about gentle support options? Explore Colic & Wind Oral Liquid and see how to use Infants’ Friend.
- Got a question? Contact us.
AUST L 367810. Always read the label and follow the directions for use. If symptoms persist, talk to your health professional.
