“Should I be worried about my baby’s flat head?”
This is a common question from parents in the early months of infancy.
Plagiocephaly refers to flattening or asymmetry of a baby’s head shape. It is common in young babies because their skulls are soft and rapidly growing. While many families first notice the visible flat spot, at ACCC we look at more than head shape alone.
Head shape can give us useful information about how a baby is moving, adapting, and developing.
Research has identified associations between plagiocephaly, positional preferences, asymmetrical movement patterns, and neck tension. When assessing babies with plagiocephaly, we are often considering a few key questions:
Plagiocephaly is often described as a cosmetic concern. In practice, head shape can also reflect broader movement and developmental patterns. At ACCC, our focus is function. We assess how a baby moves, regulates, and interacts with their environment, as this helps us understand how their nervous system is adapting.
The first thing we assess is the degree of asymmetry.
We observe and measure head shape to understand the extent of flattening and whether the pattern is improving, worsening, or staying much the same over time. Some babies present with mild asymmetry that improves with positional changes, increased tummy time, and more varied movement opportunities.
Others present with more significant flattening, often reflecting a stronger preference for turning or resting in one direction.
A 2023 systematic review by Blanco-Diaz and colleagues found that conservative interventions such as repositioning and movement-based approaches may be beneficial, particularly when introduced early.
The degree of asymmetry helps guide assessment and how closely we follow development over time.
The second area we assess is neck mobility.
Can the baby comfortably turn their head equally to both sides, or is one direction clearly easier?
Many babies with plagiocephaly also present with tightness through the neck muscles, often referred to as congenital muscular torticollis.
This may present as:
One study found that 84% of infants who developed occipital plagiocephaly after birth also had associated torticollis. Additional research has shown reduced neck movement in over 90% of infants with deformational plagiocephaly.
Head shape and movement patterns are closely related. A baby who cannot comfortably turn both ways will often spend more time resting on one area of the skull, increasing repeated pressure through that region. Restricted neck movement can also influence milestone development. Skills such as tummy time, head control, rolling, and reaching provide important sensory and motor input to the developing brain.
A 2024 study by Park and colleagues found postural asymmetry associated with plagiocephaly correlated with delays in early milestones such as lying and rolling. This is why we assess movement quality alongside head shape.
One of the most useful questions we ask parents is whether their baby can do their baby jobs with ease.
These early jobs include:
When these early jobs feel hard, it often gives us important clues about how a baby’s nervous system is functioning. A baby holding tension through the neck, jaw, or body may feed differently, settle differently, and move differently. This is why we take a whole-body approach when assessing plagiocephaly.
A flat spot often reflects broader movement patterns. It may also relate to how a baby is feeding, resting, settling, and adapting to their environment.
No two babies present the same way. Looking at head shape, neck mobility, and movement together helps us understand what a baby’s body may be communicating. Early support can help babies build more balanced movement patterns and strong developmental foundations. If you have noticed a flat spot developing, or you are unsure whether your baby’s head shape is worth exploring, an early assessment can provide clarity and practical guidance to support your baby’s development.
References