Flat Heads... #2 Simple Steps for Improvement!

Series Information:

1 in 5 babies go through a period of having some flattening of their skull as a result of external forces (the position they are in) which is often called positional or deformational plagiocephaly. In a well baby without developmental concerns, the natural course of this presentation is normally very good. It is a condition though that can cause a lot of stress and worry for parents, therefore I have completed a 3 part series to provide some information and practical tips. If you are concerned, it is important to see your local relevant health professional to best understand exactly what is happening with your bub!

There are 3 articles in this series on Flat Spots / Plagiocephaly:

  1. Flat Heads… #1 Ask The Right Questions!

  2. Flat Heads… #2 Simple Steps for Improvement

  3. Flat Heads… #3 What about helmets?

For other similar articles, please see the Baby and Kids Physio Facebook page or The Movement Team’s Paediatric Physiotherapy Page.

3 Simple Steps for Improvement…

Things a Parent Can Do At Home!

The best approach to managing or avoid a flat spot is to correct the reason it developed in the first place. Changing positioning and a baby’s movement patterns is the most effective early treatment of this condition (1,4,6). Therefore your focus here should not be on ‘fixing’ the head, but on addressing your baby’s positional preferences and removing the external force that has caused the problem. There are a few key strategies to help you do this:

1. Assisted Head Turn

(also called counter-positioning)
When possible, position your baby with their head turned to their non-preferred (non-flattened) side. This could be when going to sleep or when held in your arms.

2. Strengthen the ‘Other Side’

Use toys, mirrors or your own face to help motivate your baby to use their own muscles to turn to their non-preferred side. Engage with them regularly on that side with talking, singing and eye contact! This strategy will help your baby by building even muscle strength and allowing them to get accustomed to being on their previously non-preferred side.

3. Get Moving!

Early movement skills do kick start a babies overall development. In this case, the more advanced your baby’s movement skills, the less likely they will spend a lot of time lying on the back of their head! Check out the Baby and Kids Physio Facebook page for more, but we know that a babies development is something that you can easily encourage with basic daily strategies. To start with practice and encourage short and regular attempts at tummy-time, sitting and crawling.

These steps are great start to address the most common underlying reasons why your bub might have developed an altered head shape. If you do not see slow but steady improvement (first in their head control and movement, and then secondly and slowly in their head shape)

It is important to continue to abide by the Sudden-Infant-Death Syndrome (SIDS) safe sleeping guidelines despite any concerns regarding your child’s head shape. Focus on changing your baby’s habits during the day when supervised rather than while asleep at night.

For more, please check out the Paediatric Physio section of The Movement Team’s website.




B.Phty (Hons), G.D. Paed. Neuro. Rehab.

Tim has 10 years of Physiotherapy experience and is experienced in Paediatric (Baby’s and Children’s) Physiotherapy. 

Tim is co-owner and director of The Movement Team. Tim also holds an Advanced Physiotherapist position within a Child Development Service in the public health sector.

Tim has worked across the breadth of paediatric health (acute hospital, disability care, developmental, community and private clinics) and has completed numerous national and internationally recognised education courses in topics including developmental orthopaedics, high risk infant management, respiratory functioning and infant movement.

Tim's formal training consists of:

Bachelor Physiotherapy (Hons) - University of Queensland

Graduate Diploma Paediatric Neurological Rehabilitation - University of Western Australia

Tim additionally holds the following positions and memberships:

Chairperson of the Queensland Paediatric Physiotherapy Clinical Network 2013 - 2016

Child Development Service Team Leader - 2016/2017. 

Australian Physiotherapy Association Member


Please note that the clinical information included in this article is of a general nature and might not apply to every family. Please see your local health professional for individualised developmental advice.

Short Reference List:

1. Van Wijk, R.M., et al., Helmet therapy in infants with positional skull deformation: randomised controlled trial. Vol. 348. 2014.

2. Robinson, S. and M. Proctor, Diagnosis and management of deformational plagiocephaly. J Neurosurg Pediatr, 2009. 3(4): p. 284-95.

3. Bialocerkowski, A., Physiotherapy reduces the risk of deformational plagiocephaly in infants who have a preferred head position when lying supine. Australian Journal of Physiotherapy, 2008. 54(4): p. 283.

4. Flannery, A.B., W.S. Looman, and K. Kemper, Evidence-based care of the child with deformational plagiocephaly, part II: management. J Pediatr Health Care, 2012. 26(5): p. 320-31.

5. Ehert, F.W., et al. Differential Diagnosis of the Trapezoid-Shaped Head. The Cleft Palate-Craniofacial Journal, 2004. 41: p13-19.

6. Looman, W.S. and A.B. Kack Flannery, Evidence-Based Care of the Child With Deformational Plagiocephaly, Part I: Assessment and Diagnosis. Journal of Pediatric Health Care, 2012. 26(4): p. 242-250.