Recognize the signs of plagiocephaly early to support healthy skull development during your baby’s first months of life. Plagiocephaly, often called flat head syndrome, occurs when an infant develops a flattened area or uneven head shape, most commonly due to external pressure on the skull. At Pediatric Neurosurgeons of New Jersey, Dr. Tim Vogel provides expert evaluations to determine the cause of your child’s head shape changes and recommends the most appropriate treatment when needed.
The Anatomy
Your baby’s skull is made up of several separate bones connected by flexible bands of tissue called cranial sutures. These sutures allow the skull to expand as the brain grows rapidly during infancy while also making it easier for your baby to pass through the birth canal. Because these bones have not fused together, an infant’s skull is naturally soft and more easily molded by gentle, repeated pressure.
During the first several months of life, prolonged pressure on one area of the skull can gradually change its shape, leading to a flattened spot or asymmetry known as plagiocephaly. In most cases, the sutures remain open, and the skull continues to grow normally despite the change in shape. This differs from craniosynostosis, a separate condition in which one or more cranial sutures close too early and may require specialized evaluation and treatment.
The Symptoms
- A flattened area on one side or the back of the head
- An uneven or asymmetrical head shape
- One side of the forehead appearing more prominent than the other
- One ear positioned slightly farther forward than the other
- Uneven facial features, such as the cheeks or jaw
- A head that appears wider or longer than expected
- A persistent preference for turning the head to one side
- A flattened area with less hair due to repeated pressure
- Difficulty achieving a balanced head position if torticollis is present
- Changes in head shape that become more noticeable over time during infancy
The Prevalence
Plagiocephaly is one of the most common skull-shape differences seen in infancy. Positional plagiocephaly, the most common form, affects an estimated 20% to 25% of infants during the first few months of life, with studies reporting that approximately one in five babies has some degree of head flattening by 6 to 8 weeks of age. Although flat head is common, most cases are mild and improve with early conservative measures like repositioning and supervised tummy time. Prompt evaluation remains important because some head shape abnormalities may instead be caused by craniosynostosis, a different condition in which one or more skull sutures close prematurely and may require treatment by a pediatric neurosurgeon.
Risk Factors for Flat Head Syndrome:
- Consistently sleeping with the head turned to the same side
- Limited supervised tummy time while awake
- Congenital muscular torticollis causing a preference for one head position
- Premature birth and a softer, more moldable skull
- Extended time in car seats, swings, or infant carriers
- Multiple births, such as twins or triplets
- First-born infants with less room during pregnancy
- Assisted delivery using forceps or vacuum extraction
- Low activity levels during early infancy
- Congenital conditions affecting muscle tone or movement
The Treatment
Treatment for plagiocephaly depends on your child’s age, the severity of the skull asymmetry, and its cause. Mild cases often improve with repositioning, increased supervised tummy time, and, when needed, treatment of associated torticollis through physical therapy. If the flattening is more significant or does not improve with conservative care, a custom cranial molding helmet may be recommended. Dr. Vogel develops individualized treatment plans to support healthy skull growth while minimizing unnecessary intervention.
Schedule Your Consultation
Dr. Tim Vogel is a double board-certified, dual fellowship-trained pediatric neurosurgeon with 25+ years of experience treating complex neurological conditions in infants and children. As the Chief of Pediatric Neurosurgery at Joseph M. Sanzari Children’s Hospital, he offers advanced clinical expertise with compassionate care. If you have concerns about your child’s head shape or development, schedule a consultation with Dr. Vogel for personalized treatments.
