About Flat Head Syndrome

About Flat Head Syndrome


Flat Head Syndrome is a common term that refers to a variety of medical conditions. This web site addresses head flattening to the back of the head (Brachycephaly) or to one side of the head (Plagiocephaly) caused by pressure on one area of an infant’s head over time (Positional). Head flattening due to other reasons such as Craniosynostosis, which can be a serious medical condition, are not addressed in this web site. If flattening is noted, it is recommended that it be evaluated by your child’s doctor for the correct medical diagnosis.

Plagiocephaly, Flat Head SyndromePlagiocephaly
Positional or defomational plagiocephaly refers to an asymmetrical shape of the head caused by repeated pressure to one side of the back of the head. Plagiocephaly literally means “oblique head” which is derived from the Greek words “plagio” meaning oblique and “cephale” meaning head. When looked at from above, the head shape has a parallelogram appearance. This shape is characterized by flattening on one side of the back of the head, and a noticeably rounder shape on the other side. When looked at from above the baby’s head, one ear may look more forward than the other. The forehead on the same side as the flattened area may bulge more than the other side (bossing). Asymmetry of facial features may also be noted such as cheekbone prominence, eye orbit shape and/or jaw dysmorphology.

Positional Brachycephaly refers to a condition where the head is disproportionately wide compared to it’s depth. It is caused by prolonged positioning on the back of the head. The head flattens uniformly, resulting in a head shape that is very wide and short. There can also be Increased head height on the back of the head.

Torticollis is a condition in where the head persistently tilts to one side, and the head is usually turned to the opposite side. It is also called “wry neck”. It can be caused by congenital muscular torticollis or it can be an acquired torticollis. Congenital muscular torticollis can be caused by birth trauma or intrauterine position and results in a shortening or tightness of the sternocleidomastoid muscle. Acquired torticollis occurs because of another problem and usually presents in previously normal children. There are many causes of acquired torticollis. Infants with torticollis have a high risk for plagiocephaly. If the torticollis is not treated, facial asymmetry is common.

Craniosynostosis is condition of the skull that is characterized by the premature closure of one or more of the joints (sutures) of the bones of the head. This results in an abnormally shaped head because the brain is not able to grow into its natural shape. Instead, growth occurs where the joints have not yet closed. This diagnosis is a serious medical condition!


There has been a significant increase in the number of infants with Flat Head Syndrome in recent years. In 1992, the American Academy of Pediatrics launched the “Back to Sleep” Campaign. This campaign has proven to be highly successful in saving infants’ lives. However, this campaign, combined with the proliferation of convenient equipment such as infant car carriers has resulted in infants spending more time on their backs than ever before. Each infant should still sleep on their back unless otherwise directed by their physician.


There is no definitive study on the rates of occurrence of Flat Head Syndrome in the United States today. A 1996 study cites a six-fold increase in rates of incidence after implementation of the “Back to Sleep” Campaign, jumping from 1 in 300 infants to 1 in 60. Today, studies cite incidence rates as high as 48% in otherwise healthy infants.


The American Academy of Pediatrics recommends that physicians screen infants for persistent head flattening at the 2 or 3 month well-baby visit. The diagnosis of Plagiocephaly, Brachycephaly, and or Torticollis is given by a physician.


The following could be signs of head flattening:

  • head turned one way most of the time
  • head tilted to one side most of the time
  • flat spot on back or one side of the head
  • bulging on one side of the head
  • one ear more forward than the other
  • asymmetry of the face

Risk Factors

Some infants are more likely to develop head flattening and/or Torticollis. Clinical literature has identified some characteristics of infants who more commonly are developing head flattening:

  • male infants
  • first born in birth rank
  • a head shape, at birth, that is naturally wider than deeper
  • multiple birth (twin, triplet, etc)
  • a diagnosis of hip dysplasia
  • altered tone (decreased or increased tone)
  • a diagnosis of reflux

Associated Problems

In recent years, clinical studies have been done to investigate what long term effects might be associated with a diagnosis of head flattening and/or torticollis. More studies are being done to get more data
and information, but current literature gives evidence that infants with plagiocephaly and/or torticollis may have other associated problems such as:

  • A high risk for learning delays and developmental delay
  • Increased neeed for special services when the child reaches school age
  • Othodontic and TMJ issues
  • Scoliosis
  • Visual disturbances including visual field defects, and astigmatism
  • auditory problems
  • Psychological/social issues

Prevention and Treatment Window

Most of a child’s skull growth occurs during infancy. Skull growth slows and the skull hardens through toddler years. Early prevention and treatment are important. After a child reaches one year of age, the window for treatment quickly closes.

This web site is not intended to make a diagnosis or recommend treatment. If you notice any of the symptoms listed above, see your pediatrician or family doctor right away.