Plagiocephaly and brachycephaly (flat head syndrome) 

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Babies sometimes develop a flattened head when they're a few months old, usually from sleeping on their back.

It's known as "flat head syndrome" or "moulding" and there are two types  plagiocephaly and brachycephaly (see below).

If a baby has a flattened head, it isn't usually a cause for concern because it will often correct itself over time.

Plagiocephaly and brachycephaly

The two types of flat head syndrome in babies are: 

  • Plagiocephaly  this is the most common type and occurs when the head is flattened on one side, causing it to look asymmetrical and distorted. For example, the ears may be misaligned and when seen from above the head, looks like a parallelogram.
  • Brachycephaly  this is when the back of the head becomes flattened, causing the head to widen. To compensate, the front of the skull sometimes bulges out.

What causes plagiocephaly and brachycephaly?

The skull consists of plates of bone, which start to strengthen and fuse together as a child develops and gets older.

A young baby's skull is still soft enough to be moulded and change shape if there's constant pressure on a particular area of their head.

The following information explains:

  • Why some babies are affected.
  • What you can do to help correct it.
  • The outlook for your child.

Why some babies are affected

A baby's sleeping position is the main cause of plagiocephaly and brachycephaly, although there may be other factors at work.

Sleeping position

Plagiocephaly and brachycephaly are often caused by a baby sleeping on their back every night.

Should the back or one side of the baby's head (if their head naturally rolls to the side) be squashed against a firm mattress, the soft bone of their skull can become flattened.

Once their head is flattened, it will automatically stay on the flattened side or roll towards it. This will then become their preferred side for sleeping and for resting their head during the day.  

However, don't change your baby's sleeping position from lying on their back at night. It's very important for babies to sleep on their back, because it reduces the risk of sudden infant death syndrome (SIDS).

Instead, you should change your baby's position during the day, to relieve some pressure from the flattened area (see below).

You can buy specialist curved mattresses that are designed to distribute the weight of a baby’s head over a larger area, so that less pressure is placed on any point of their skull. However, there's a lack of scientific evidence demonstrating that these mattresses are effective in treating or preventing plagiocephaly.

Factors in the womb

Flattening of a baby's skull can sometimes occur in the mother's womb.

There may not be enough amniotic fluid inside the womb to cushion the baby (known as oligohydramnios). This means the baby's head can become temporarily deformed as they travel down the birth canal.

This tends to happen more often in multiple births  for example, when twins squash against each other inside the womb.

Premature births

Premature babies are more likely to have a deformed skull because they're squeezed through the birth canal when their skulls haven't fully developed (the skull strengthens during the last few weeks of pregnancy).

Babies born prematurely tend to be nursed with their head on the side (alternately), which means they can develop a longer, thin head. As these babies are born early, they also have a longer period of time before they develop head control and are able to spontaneously move their head.

Muscle problems

A baby will sometimes have tight muscles in their neck, which prevents them from turning their head a particular way.

This causes them to always rest their head on the other side, flattening it. Physiotherapy can be used to help correct this problem (see below).

Craniosynostosis

A flattened head can sometimes be caused by the bony plates of a baby's skull joining together too early. This is known as craniosynostosis.

This can pull the baby's head out of shape and may need to be corrected with surgery (see below).

What you can do

Treatment may not be necessary in mild cases of plagiocephaly or brachycephaly.

Your baby's skull should correct itself naturally over time if you take some simple measures to take pressure off the flattened part of their head and encourage them to try different positions.

You should:

  • Give your baby time on their tummy during the day and encourage them to try new positions during play time.  
  • Switch your baby between a sloping chair, a sling and a flat surface, so that there isn't constant pressure on one part of their head.
  • Change the position of toys and mobiles in their cot to encourage your baby to turn their head to the non-flattened side.
  • Consider physiotherapy if your child is only able to turn their head one way; tight neck muscles may be preventing them from turning their head to the other side.  

You may need to try these measures for six to eight weeks before you notice an improvement in the shape of your baby's head.

In cases of craniosynostosis, where the plates of your baby's skull have fused too early, surgery may be needed to move the bones.

Read more about how craniosynostosis is treated.

Headband or helmet therapy

Helmets or headbands, known as cranial orthoses, improve the symmetry of a baby's skull.

These custom-made devices apply pressure to "bulging" parts of the skull and relieve pressure from other parts, allowing growth in the flatter areas. The device may also prevent your child lying on the flattened part of their head.

Cranial orthoses are designed to be used while a baby’s skull is still soft and malleable. Treatment should be started when the child is around five or six months old. To be effective, the device should be worn continuously (up to 23 hours a day).

Helmet therapy usually takes three to six months to complete and is often used until the child is about 14 months old. However, it can sometimes take longer for treatment to be successful.

The use of helmets and headbands is controversial, and they're not available on the NHS. This is because there's not enough evidence to show whether a helmet or headband will make any improvement to the shape of your baby's head if the above measures are taken early on.

Other things to consider:

  • Cranial orthoses – these are expensive, costing around £1,700-2,500.
  • Your baby will need to be checked every six weeks to make sure that the device is allowing (and not restricting) head growth, and for any necessary adjustments.
  • The device may be uncomfortable, and there's a risk it will cause pressure sores on your baby's head.

Outlook

Mild flattening of the head will usually correct itself if you use the simple measures outlined above, which are designed to relieve pressure from the affected area of your baby's head.

More severe cases of plagiocephaly and brachycephaly can still be improved over time, although some flattening will usually remain.

As your child’s hair grows and they develop good head control, the cosmetic aspect should improve. It’s very rare for a child to be referred back to a specialist when they reach school age because of teasing.

A helmet or headband can be used to help correct the shape of your baby's skull, but it may not work in all cases. You should consider the inconvenience, expense and possible discomfort to your child before trying a headband or helmet.

Also, the lack of scientific evidence that these devices do more than the measures outlined above makes it difficult for the NHS to support their use.

Page last reviewed: 29/04/2014

Next review due: 29/04/2016

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Comments

The 14 comments posted are personal views. Any information they give has not been checked and may not be accurate.

WoodyM said on 25 June 2014

There is a company in Manchester, called Sleepcurve, who produce a mattress that can be used to prevent / treat Plagiocephaly.
It has been studied at Alder Hey Children’s Hospital and they reported it to be 'an effective treatment solution' at the International Society of Cranial Facial Surgeons in September 2013..
The guy who designed the Sleepcurve mattress is an osteopath specialising in paediatric plagiocephaly called Philip Owen. He has a site called flatheadsyndrome.org.uk - which has some useful info.
It seems like Positional Plagiocephaly (Flat Head Syndrome) is a very common condition (a recent Canadian study reported that 47% of children have it) although severe cases are quite unusual I believe. From the comments shown here it looks like many parents do not think this condition self corrects.
I understand that the NHS doesn't want to pay for cosmetic treatments but it is a mistake to dismiss the effects of a misshapen head on a child's confidence and well-being. (There are also medical reports about the syndrome having an effect on mental development).
I am writing this because the therapies often promoted – ie helmets – are so much more expensive (£1000 plus) and I have seen news items about parents fund raising to get the money together to get a helmet – when there is a treatment that is only about £50 to £150.
Hope this is of help to parents concerned about Flat Head Syndrome and want a cheaper or less obtrusive alternative to a helmet.

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LTC22 said on 26 March 2014

I noticed HFLYNN2 said her sons plageocephaly has caused an eye squint. This has happened to my daughter too. Her flattening is to the left and she has also developed a squint in her left eye.
We currently live in Germany and the health system over here is very pro helmets. Despite a British paediatrician saying it would rectify itself, we had a number of German health professionals, including two paediatric cranial orthopaedists, stating it would not. Her head was examined and we were told her asymmetry was 15 degrees. Anything over 10, in their opinion, would not rectify itself completely. Her face, ears and head are distorted.
This is not just an aesthetic problem, it has caused her delayed motor development and if untreated is likely to cause muscular imbalance in the neck and spine. As well as the now discovered squint which she is awaiting treatment for. She has had months of repositioning and physiotherapy and although it has helped with the mobility on her neck to encourage her to lay her head to the left and right, it has not helped the flattening.
We are lucky she is now being treated, although as we've had to go through British medical services as well, it has taken 5 months for us to get to this point. She is now 10 months old. Her identical twin sister is fine and does not have the squint, if this was genetic then she would have it as well.
We do not know for sure that the helmet therapy will work but as her parents it is our job to make sure we do everything we can to try. The helmet does not put pressure on the 'bulging' area. It fits this area so growth is restricted here. It then leaves a gap where the flattening is so the head can grow into the gap.
My concern is we have too move back to the uk prior to the helmet therapy finishing and we may not be able to continue with it as a result as it's not offered on the NHS.

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Redsky80 said on 16 March 2014

Finally the NHS may be realising that severe cases of plagiocephaly and brachycephaly may not correct themselves (as stated above 'more severe cases may still improve over time but some flattening usually remains')
I feel it is extremely irresponsible of health professionals to tell parents that head shape will definitely correct over time when we just don't know. The fact that there is a Yahoo support group with 2000+ members for parents of older children with untreated plagio suggests that for some babies self correction does not happen. If parents choose to go ahead with helmet therapy there is only a small window of time when it is effective, so no time to be wasted on bad advice. The only way that the NHS will be able to recommend helmets is when we have good quality trials which prove they work better than repositioning alone. Until then parents are in the very difficult position of weighing up all the conflicting information to make the most informed decision we can.
My personal opinion is that self correction will often happen if it is caught at an early age and before it is too severe, but that if the baby is older and the plagio/brachy is severe then there are no guarantees that it will correct without treatment.
I have twin boys who both had plagio, one more severely than the other. The less severely affected twin completely self corrected with repositioning but the more severely affected twin became worse and worse despite our best efforts so we got him a helmet. It worked brilliantly. I am 100% sure that due to the severity of his plagio and the fact that it only got worse before we got his helmet (at 7 months) it would not have self corrected.
I am sure that in time trials will show the benefits of helmets in severe cases and they will become a common treatment without the controversy. I am so glad we took action before it was too late. Trust your instincts and good luck with whatever decision you make.

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LVJEN said on 07 March 2014

My daughter is now 4 months and we have just been to see the HV. At around 1 month I have noticed my baby's head flattening at the back despite doing the advice to change position regularly. I have always mentioned this to the HV who kept reassuring us that position changes will correct it. No it is morenoticeable as a different HV pointed it out and referred us to physio. I am increasingly mre anxious now after reading the comments because my 1st daughter's head is flat at the back and has had problems with having on/off lazy eye. That had been seen bybthe opthalmologist who said there was no problem at all. That she'll outgrow it. She's 7 yrs old now and at school her friends seem to notice it a lot of times. My point is if the eye problem could have been due to her brachycephaly had been misdiagnosed or undiagnosed, what's going to happen with my new baby's head and vision or worse hearing if the NHS will continue to ignore this as a major problem? the conservative management of position changes is definetely not working regardless of how much teaching they giveto parents. After reading the other comments, I surely will start looking for treatment rather than wasting my time listening to HV for reassurance as my daughter's confidence and happiness is paramount. Thank you to other parents who shared their views. Please could you tell me where to get the treatment from. Thank you.

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HFlynn2 said on 05 March 2014

This is not a cosmetic issue!
I have a 7month old son with severe plagiocephaly were the left side of his head is flattened. It has now been identified that this has caused damage to his left eye. He has developed a squint or turn in his eye. I can confidently say he would not have developed this anyway as he is an identical twin and his brother has no eye problems. Vision problems in babies does affect development, this is a medical issue!
Treatment is available on the NHS! There is a hospital in Bristol that provides the headband treatment on the nhs. I will be asking for my gp to refer us but am afraid the waiting time will be too long and I will be forced to go private.
I feel let down by health professionals who assured me it would rectify and now my son could face permanent damage to his eye.
Devastated mum of beautiful twin boys

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Rheanna2013 said on 09 September 2013

I am a mum to a 6 month old boy. Since he was around 3 months we noticed his head was much flatter on one side. As any parent would do, we went to see our GP and health visitor - both said that it will correct itself in time and by the time he is sitting up, crawling etc his head will get better. It has not got better at all and has even got worse. I put my trust in my GP and health visitor but now I trust my instincts!!!! We have been researching and reading case studies regarding the helmet and reading all of your below comments I am ready to accept the helmet!
If you have been told it will get better in time - do not believe it at all!! yes its an expense and we have had to get a loan but my sons health and happiness outweighs all of the negative areas!!!
I am positive he will be fine and thank you for all your comments....!

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Kkrajewska said on 29 August 2013

I am a mum of a 5-month old baby boy with flat head. I have been worried about it as our little one's head has become increasingly flatter as he grew. We have tried both, the tummy time, the 'keep him upright as much as possible' advice from midwives as well as going against their advice and using anti-flat head pillows (shock, horror!). Nothing worked so far.
As a mother, you just know something is wrong, call it mother's intuition but you get that feeling. I pressed my GP for a referral to a pediatric specialist and got one... more than 2 months away! Having read your stories I really doubt NHS will do anything about it other than tell me things will improve, which I feel won't without treatment, which in turn is non-existent at the moment.

This is thanks to you, other parents of babies with similar condition, for sharing your stories, that we took our own initiative and booked an appointment with a private clinic and will be assessed (for free) next week. Not only the clinic recognized this as a real problem (as opposed to midwives and HVs who brushed it away and kept saying it will improve on its own), the process was explained to us very thoroughly and costs discussed upfront.

We are hopeful, and for this we thank you.

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AnnMarie35 said on 12 August 2013

My daughter was diagnosed with severe brachycephaly when she was 10 months old. We took her to the doctors on 2 separate occasions between 4 and 6 months of age, in which we were told 'not to worry' and that it would get better! By the time she was 10 months old, her head across the back looked like a cliff edge and we were devastated. Once we went private, we were immediately faced with the seriousness of her condition and decided immediately to have her fitted with a helmet. Due to the time we had wasted because of the GPs advice, we had lost the best opportunity of growth and natural improvement. Our daughter wore the helmet for 11 months when we reached a point where we didnt think it was going to get much better. Whilst we are happy with the results and glad that we went ahead with the helmet, until guidelines are changed, other babies will have to go through exactly the same thing which isn't fair. It isn't an 'aesthetical issue' but a deformity which needs to be addressed. A babies head shape is so important and being told by your GP that 'her hair will cover it' isn't the answer! I have been campaigning for 18 months now and managed to get the above information on NHS Choices. Whilst it isn't 100% accurate, it is better than what was there before, which was nothing. I have also had an article published in Primary Health Care magazine to try and make clinicians aware of this condition and to take action and have also been in touch with NCT, Bounty and am awaiting a response from Mother & Baby magazine to try and get an article published in there. Helmets wouldn't need to be provided if awareness was raised in the first place and parents could take action before it was too late. I just wish that the NHS would look at the messages above and acknowledge that more research needs to be done into this condition. Hopefully given time, we will get through to the NHS so that other babies don't have to go through this.

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Vikki66 said on 30 July 2013

The following sentence is quoted by the NHS "No treatment is required for mild cases of Brachycephaly and Plagiocephaly" a very misleading statement as it implies that for severe cases treatment is necessary! Yet they still do not offer any treatment for the unfortunate babies that have severe measurements!

I as a parent of a baby who has been diagnosed with Severe Brachycephaly and Severe Plagiocephaly is extremely disappointed in the Health Care Professionals for there very little knowledge and no offer of treatment for my baby and all the other babies with these conditions. I have to go to extreme lengths to fundraise the cost of treatment, meaning I am relying on the kindness of friends, family and strangers to allow my son to have treatment!

Another mistake by the NHS is that they state that "These custom-made devices are designed to be used in infants aged 6 to 12 months, to apply pressure to "bulgy" parts of the skull and relieve pressure from other parts, enabling growth in the flatter areas of the skull."

My son is wearing a helmet at present and they do not apply any form of pressure on his skull. They are made to fit the shape of the skull leaving a gap where the asymmetry is and allows the skull to grow and fill this gap.

The NHS clearly have to do a bit more research and get their facts correct before publicising false information on their website.

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Kirstyjane8 said on 03 June 2013

I looked into having my 11 month old daughter fitted for a helmet but instead we decided to have her visit a Chiropractor. After just 12 sessions, each only lasting 10 minutes, we are already seeing a difference in her head shape. The Chiropractor gently massages the head, encouraging the skull plates to shift position. I am delighted with the decision we made and only wish that there was more information on Chiropractic care available to parents in this position.

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Mexmagic said on 22 August 2012

My son was diagnosed with severe brachycephaly at 4 months and wore a helmet for 6 months to correct this. It was a condition which was not going to correct itself no matter how much we respositioned him. It was enough of a reason for us the fact that is head would be very different from his peers when he started school to convince us our decision was the correct one. Not to mention the visual and auditory problems which in rare circumstances can present themselves. We would never have forgiven ourselves if our son was the victim of bullying as a result of our decision to ignore the problem.
Yes it is expensive but my child´s happiness has no cost. Yes he had to wear it for 6 months, 23 hours a day but he was small enough not to realise this was not normal and caused him very little discomfort. It was the correct decision and as a parent you know in your heart when something isn´t right and you have to do something about it.
Just to clarify some of the info. above. the helmet does not put any pressure on the baby´s head. It merely holds or maintains the normallly shaped areas and leaves space for growth around the flat areas. Used correctly, following all the indications, it needn´t cause soreness or discomfort.
I hope this is useful to other parents out there recognising an odd shape to their baby´s head. Don´t leave it too late to ask questions and get treatment if that´s what you decide.
My son is perfectly fine now and will never even remember his 6 months of helmet wearing.

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kateandbenji said on 25 May 2012

Getting our son a helmet has been so beneficial and has been the best choice for our situation. He was a breech baby who was very wedged inside me resulting in torticollis, he favoured lying on one side therefore resulting in flattening. We had physio for his neck and were told his head would even out. However we were very concerned as the asymmetry was showing in his facial features. We decided to investigate helmet treatment and on measuring his head we discovered that he had severe plagiocephaly - the correction needed was 32mm. We tried repositioning for a month before the helmet was fitted with no success, it increased to 33mm. He has been wearing his helmet for 3.5 months now and has responded brilliantly - he has reduced his plagiocephaly down to 18mm and we still have a few months until his skull hardens and things slow down so we hope to get to single figures. We are not trying to make him perfect as everyone has a degree of asymmetry but we are trying to make it so that it isn't noticeable anymore.

What really concerned us is that it isn't just 'cosmetic'. It can cause the jaw to not form properly and differences in eye shape/size. Our son is waiting to have these checked out as his plagio was so severe and he does have very different eyes.

The helmet has caused us no problems, he accepted it straight away and doesn't even seem to know it is there.

Best of luck to anyone with a child with plagio. Every situation and child is different and there are lots of routes to explore. We are glad we have done what we have and would do exactly the same again.

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mummys 2 boys said on 12 May 2012

Love the part in the article where they say it's just a cosmetic problem and a few lines down it says what you can do to correct this deformity, That in itself is a bit of a contradiction, as deformity and cosmetic have different meanings.
We followed the repostioning advice for our son as he was born with severe brachy and plagio. Our son had Physio from 2 wks old which did make an improve to his plagio, our son was still having physio at 8 mths old as he still had severe brachy which hadn't seen any improvement at all. At 7 mths we had decided to go for the helmet and just before he turned 8 mths he was wearing his helmet full time. Our son stayed in his helmet for 8 and a half months, and putting him in a helmet was the best decission we ever made.

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fiona1272 said on 21 April 2012

It is good to see that the NHS are recognising the helmet therapy. I would like to share my experience with parents who are reading this and maybe considering the therapy. I have two children, a daughter aged 9 and a son aged 2. We discovered our daughters plagiocephaly when she was nearly one, at around that time we also noticed her head would not sit straight, she had torticollis which restricted her head movement, we received physio and advice from the NHS but unfortunately although the torticollis corrected her plagio didn't and she still has a misshapen head, she has long hair and unless you know she has the condition you would never notice.

When our son was born we discovered he had the same thing and we received physio from the NHS but decided to get the helmet for him, partly because it was much more widely available and partly because we had experience of not using one. his helmet was fitted at 4 months and he wore it until he was 11 months old. the helmet was worn 23 hours per day and he seemed comfortable and continued to sleep through the night. In fact when it was removed he seemed to miss it for a while. he did have to learn not to bump his head into things as it would hurt but that didnt take long. It was the best thing we did for him and he now has a lovely shaped head, if I could turn back time I would have get a helmet for my daughter as well but I cant and will have to live with that.

I wish every parent with children with plagio luck and whatever decision you make will be the best for you.

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