Fear of Flat Head Syndrome


Dear Mamas,

Our newborn baby girl is 2 weeks old and we’ve been careful to always put her down on her back to sleep during the day and at night.  I know all about how important it is for babies to sleep on their backs to prevent SIDS.

I recently learned that a nephew who’s 3 ½ months old had to be fitted with a reshaping helmet because one side of his head was flattened from lying on his back all the time, and now I’m worried that the same thing will happen to my daughter. How big a danger is it and how can I prevent it?  Is avoiding a small risk of SIDS worth risking damage to our little girl’s head?

J in Chicago


Dear J,

Thank you for this question. It’s on the minds of new parents everywhere as we see more and more infants in that adorable headgear.

Before the American Academy of Pediatrics began recommending Back to Sleep, sudden infant death syndrome (SIDS) was the most common cause of death in infants under one year. Since then the number of cases has been cut in half. Great news!

But an unintended consequence of the Back to Sleep campaign has been a huge increase in the number of babies with flattening on one side of the head (technical name: flat head syndrome, or positional flattening). Infants now spend most of their time lying flat on their backs and tend to keep their heads turned to the same side. The more they do that during the first few months, the more likely they are to have one-sided flattening.

The skull bones are soft and movable to allow the head to pass through the birth canal. They have spaces in between to accommodate the rapid brain growth during the first year. When baby consistently lies in the same position, the bones can slide and mold, flattening on one side.

It’s important to note that any flattening is cosmetic only. It does not affect brain growth or development, and most cases re-mold without treatment as baby spends more time sitting upright. There are also strategies you can use to help prevent flat spots. A new report in Pediatrics recommends the following techniques:

~ Change your baby’s direction in the crib each week. This encourages him to turn his head to the other side.

~ Place an interesting toy or picture to the underused side when baby is awake to coax his attention in that direction.

~ Change sleep location periodically (crib to bassinet to infant/car seat) for a shift in the pressure spot.

~ Increase supervised tummy time when baby is awake. 30-60 minutes each day helps develop neck and shoulder muscles and enhances overall motor development.

~ Increase cuddle time. Let baby sleep against your body in a sling or infant carrier during the day when you’re up and about to reposition and take pressure off the head.  Note: Do not co-sleep due to asphyxiation risk.

 Repositioning should be the first line of correction, even if mild flattening has already occurred. It has been shown to be just as effective as molding helmets and is undoubtedly more comfortable for baby (imagine wearing the equivalent of a football helmet all day long). Surgery should only be considered in the most severe cases after all other remedies have failed.

So never fear, there are ways to keep your new baby safe (isn’t that the most important thing?) and keep her little head symmetrical at the same time. No need to choose one in favor of the other.

Congrats on your new addition …

~ the Mamas



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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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