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My Baby Has a Flat Spot on Their Head. Now What?

What you need to know about plagiocephaly: what it is, what to do at home, and when to get help.


You are bathing your baby and you notice it: one side of the back of their head is a little flatter than the other. Or the whole back seems wider and shorter than you expected. Your mind goes straight to the internet. And then the worry sets in.


Take a breath. This is one of the most common things we see in newborns and young infants. The medical term is positional plagiocephaly (flat spot on one side) or brachycephaly (flattening across the whole back of the head). According to the Canadian Paediatric Society (CPS), plagiocephaly peaks at around 4 months of age and affects up to 19.7% of infants at that stage. Most cases improve. And there is a lot you can do right now at home.




Why Does This Happen?


The Back to Sleep campaign, launched in Canada by Health Canada, the CPS, and the Canadian Foundation for the Study of Infant Deaths, dramatically reduced SIDS deaths. But placing babies on their backs for sleep also meant more pressure on the back of the head during those long stretches of rest. Research has since documented a significant increase in positional head flattening as a result.


A newborn's skull is soft and malleable by design. This allows the brain to grow rapidly in the first year of life. But that same softness means that sustained pressure in one area, even from sleeping, can leave a flat spot.

Other contributing factors include:

  • A preferred head position due to tight neck muscles (torticollis)

  • Prematurity, which means more time spent lying in one position in the NICU

  • Multiple births, where space in the uterus creates positional constraints

  • Extended time in car seats, swings, and bouncers that keep the head in one position

 

Important distinction: Positional plagiocephaly is caused by external pressure and is different from craniosynostosis, where the skull bones fuse too early. The two conditions can look similar. The CPS recommends that all infants with plagiocephaly be assessed to rule out craniosynostosis and torticollis. If you are unsure, ask your care provider.

 

What You Can Do at Home Right Now


The CPS and Health Canada recommend supervised tummy time for every awake baby: at least 10 to 15 minutes, three or more times per day. This is the single most important thing you can do to prevent and improve positional head flattening.

If your baby dislikes tummy time at first, that is completely normal. Here is how to build their tolerance:

  1. Start with just 1 to 2 minutes at a time right after a diaper change, when they are alert and comfortable

  2. Get down on the floor with them at eye level to keep them engaged

  3. Place a rolled-up towel under their chest to make the position easier while neck strength develops

  4. Try tummy time on your chest or lap instead of the floor, which some babies tolerate better early on

  5. Use toys, mirrors, or your face to give them something to look at and lift toward

  6. Gradually increase the time as they get stronger, aiming for at least 30 minutes of tummy time spread across the day by 3 to 4 months

 

Alongside tummy time, try these repositioning strategies:

  • Alternate which end of the crib you place your baby's head to encourage them to look in different directions

  • Vary your carrying position: alternate arms, use a baby carrier to take pressure off the back of the head

  • Limit time in car seats, swings, and bouncers when not travelling or napping in them

  • When your baby is awake and alert, encourage them to turn toward sounds, your voice, or toys on their less preferred side


Have questions only a nurse can answer? We're here.



When Should You See Someone?


The CPS recommends well-baby checks within the first week, and at 2 and 4 months. These visits are the right time to raise any concerns about head shape. But do not wait if you are worried. Earlier assessment leads to earlier action, and earlier action leads to better outcomes.

Ask your care provider about a referral if:

  • The flat spot is not improving after 2 to 4 weeks of consistent repositioning and tummy time

  • Your baby consistently turns their head to one side and resists turning the other way

  • The flat spot is on one side only and seems to be getting more pronounced

  • Your baby is approaching 4 to 5 months and the asymmetry is still significant

  • You notice the ear on the flat side appearing pushed forward compared to the other

A note on timing: Research shows that helmet therapy started before 6 months of age produces better results in a shorter time. A study comparing early versus late intervention found that babies who started treatment before 6 months averaged 3.45 months of treatment, compared to 4.18 months for those who started later. If a referral is recommended, do not delay.


What If Repositioning Is Not Enough?


For moderate to severe cases, or when repositioning has not produced improvement, a cranial remolding orthosis (CRO), commonly called a helmet, may be recommended. Helmets work by gently redirecting skull growth, leaving space for the flat areas to fill out while applying light contact to the areas that are fuller.


A five-year follow-up study published in the Journal of Craniofacial Surgery (Wilbrand et al, 2016) found clear improvement in cranial symmetry in children treated with individual molding helmets compared to those left untreated. In the untreated group, absolute cranial asymmetry did not significantly improve over five years.


Helmets are most effective when started between 4 and 8 months of age, while the skull is still growing rapidly and remains most responsive to gentle redirection.

 

Side effects from helmet therapy: Are generally minor. A multi-site Canadian study tracking 453 infants at clinics in Burlington (Ontario), Calgary, Edmonton, and New Westminster found that 87% of clinic visits had no significant issues to report. The most commonly noted effects were pressure marks and temporary redness, and these were closely linked to fit quality. Well-fitted helmets, with regular follow-up and adjustments, dramatically reduce discomfort.


When a helmet is recommended, choosing the right provider matters. ROKband Pediatric Headshape Clinic is a Canadian clinic that has supported over 12,000 families since 2017, specializing exclusively in cranial care. Their helmets are custom-designed by certified orthotists using proprietary assessment software, ROKbands are 3D printed from your baby’s unique head scan and are thoughtfully designed with contoured trimlines and enhanced ventilation to help keep your baby comfortable and free to move during tummy time, play, and motor skill development. ROKband offers complimentary assessments with appointments typically available within a week and fitting completed within two weeks—an important advantage given what research shows about the benefits of early treatment. Clinics are located across Ontario, Alberta, and British Columbia.

 


How SuperNurse Helps


In those early weeks and months, it can be hard to know whether what you are seeing is mild and temporary, or something worth acting on. Our registered nurses can come to your home and:

  • Assess your baby's head shape with a trained clinical eye and help you understand what you are looking at

  • Demonstrate tummy time techniques and positioning strategies tailored to your baby, matching what SickKids and BC Children's Hospital recommend for home care

  • Identify early signs of torticollis or neck tightness that may be contributing to head shape changes

  • Advise you on when to seek a referral and help you navigate next steps if needed

  • Support consistent implementation of the positioning strategies that make the biggest difference


The earlier you act, the more options you have. That is true whether the answer is tummy time, physiotherapy, or a helmet referral. Our job is to make sure you have the right information at the right time.


Key Takeaways

  • Positional plagiocephaly is common in Canada and affects up to 19.7% of infants at 4 months. It is not a rare condition and it is not your fault.

  • It is caused by sustained pressure on a soft skull, most often from sleep position or a neck preference

  • CPS and Health Canada recommend at least 10 to 15 minutes of supervised tummy time, three or more times per day, starting from birth

  • If repositioning is not producing improvement by 4 to 5 months, ask about a referral: earlier assessment means earlier treatment and better outcomes

  • Helmet therapy is effective for moderate to severe cases. Canadian data shows 87% of helmet visits are complication-free

  • SuperNurse RNs can assess your baby's head shape at home, guide you on tummy time, and help you know when to escalate


Concerned about your baby's head shape? Book a free assessment with ROKband clinic

If follow-up care or support with your baby's care plan is needed, SuperNurse RNs are here to help you stay on track.

 

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