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Flattening on the Back of a Baby's Head

Dr. Matthew Smyth treats patients at

St. Louis Children's Hospital
One Children's Place, 4th Floor, Suite 4S20
St. Louis, MO 63110

Phone: 314-454-4454 Fax: 314-454-2818
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Question: My baby has flattening in the back of his head. Should I be concerned?

Answer: The most common cause of abnormal head shape in infants is a benign condition called positional plagiocephaly (plagio = flat, ceph = head). In this condition, the back of the infant’s head is flattened, usually on one side, due to external pressures. An infant’s skull is growing rapidly, and the bone itself is soft and malleable.

With the recognition in the early 1990s of SIDS (sudden infant death syndrome) and the relationship to sleeping position, the NICHD and the American Academy of Pediatricians recommended that infants sleep on their backs (“Back to Sleep Campaign”) in 1994. While this has decreased the rate of SIDS, it does result in more children spending more time resting on the back of their heads and has likely increased the incidence of positional plagiocephaly.

If the infant has a preferred side to turn his head, flattening can develop in the back on one side. This can be exacerbated by torticollis (head tilt). The natural history of the benign flattening is for improvement in head shape spontaneously as the child becomes older, more active, and spends less time on his back as he begins to roll over, crawl and walk. The flattening can be improved by positioning the infant on the non-flattened side during sleep, by arranging objects in the nursery to attract his attention to turn his head away from the flattened side, and by encouraging lots of supervised “tummy-time” during the day.

For more severe cases of plagiocephaly, a custom molding helmet can be prescribed by a physician and fit by a cranial orthotist, and these orthotic helmets may improve the overall head shape better than conservative measures alone.

If your child has an abnormal head shape, it most likely represents benign positional plagiocephaly. However, it should be evaluated by an experienced pediatrician, pediatric neurosurgeon or pediatric craniofacial surgeon to exclude the diagnosis of craniosynostosis, a congenital problem of premature closure of one or more of the skull growth plates. Fortunately craniosynostosis can be corrected surgically.

Newer options include minimally-invasive procedures using small incisions and an endoscope (small video camera) to release the fused bone during a short surgery with a one day hospitalization.

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