Does Your Baby Have a Flat Head?

More and more babies are getting referred to physical therapy for having a flat head. There are two main types of flat heads. Brachycephaly is when the back of the head is flat, causing the head to be wider than it is long. Plagiocephaly is when one side of the back of the head is flat. Brachycephaly is usually caused by a baby spending too much time lying on their back, while plagiocephaly is usually caused by a condition called torticollis.

Torticollis is a condition caused by shortening of the muscles on one side of a baby’s neck that usually results in tilting of the head to one side and turning to the other side. Common causes include the position of the baby in utero, traumatic birth, positioning in the same way in carseats/swings/carriers, and holding or feeding a baby on only one side.


Left untreated, torticollis can lead to a flat head. If a baby has a preference to turn to one side, they are probably turning that direction when they sleep, resulting in one side of the head getting flat. Torticollis and plagiocephaly can lead to facial asymmetry, gross motor delays, asymmetric motor development, visual motor impairment, and impairments in feeding, speech, and handwriting.

Signs and Symptoms:

  • Head held tilted to one side (ear to shoulder)
  • Inability to turn and look both left and right
  • One shoulder held higher
  • Only rolls back to stomach or stomach to back to one direction
  • Flat or bald spots on one side of the back of the head
  • Difficulty breast feeding, especially when one side is more difficult than the other
  • Poor tolerance of tummy time

What You Can Do To Prevent/Fix a Flat Head:

  • TUMMY TIME! Supervised tummy time is the best way to prevent abnormal head shapes, increase neck strength, and promote gross motor development. Shoot for at least 30 minutes every day, broken up into shorter chunks as needed. Gradually increase this time as your baby gets stronger and tolerates tummy time more. Eventually, your baby should prefer to be on their stomach so they can interact with and explore their environment.
  • Limit awake time in swings, bouncers, rock ‘n’ plays, and carseats. When you do use this type of equipment, try to make sure your baby’s head is in midline (straight, not tilted or turned to one side).
  • Try to avoid sleeping in swings, rock ‘n’ plays, or carseats, even for naps.
  • Use a carrier, such as an Ergo or Moby, to wear your baby.
  • Alternate which end of the crib or changing table that you place your baby on to sleep or change diapers.
  • Alternate the direction that your baby’s head is turned when you put them on their back to sleep.
  • Alternate the side that you hold, carry, and feed your baby on (if you are bottle feeding).

What If I Suspect My Baby Has Torticollis?

While torticollis is often due to factors beyond our control, it can be corrected with appropriate treatment. Torticollis typically requires skilled intervention to guide a family on what steps to take at home. Treatment is easiest when started as early as possible, even immediately after birth. If you think your baby has torticollis, you can:

  • Call and ask for a physical therapist to do a free screen.
  • Call and set up a physical therapy evaluation (most physical therapists can request a prescription from your doctor).
  • Ask your doctor to make a referral to a physical therapist.

Call Mosaic at (406) 388-4988 for more information or if you have questions or concerns that you would like to speak to a therapist about.