Protect your baby's natural headshape: tummy time to play, back to sleep

How to protect your baby's natural head shape and how to avoid plagiocephaly.

What is positional plagiocephaly?

Positional plagiocephaly/ brachycephaly is when an initially, typically rounded skull shape becomes flattened as a result of skull moulding. It makes the shape of your baby's head appear flat at the back or side.

What causes this?

Plagiocephaly can be caused by the position of the baby in the womb, but is more commonly seen postnatally due to the positions babies lie in.

The main cause postnatally is the amount of time babies spend lying on their backs and in car seats in their early lives when the bones of their skull are soft and can easily be moulded into a different shape due to pressure of the surface they are resting on.

Positional plagiocephaly is more common recently since the Back to Sleep campaign which advised parents to place their babies on their back to sleep to reduce the risk of sudden infant death syndrome ( SIDS or cot death). However, babies should always be placed on their back to sleep as the benefits of reducing SIDS far outweigh the risk of developing this benign condition.

What are the symptoms?

There are no symptoms other than the flattened appearance at the back or side of your babies head. It does not affect your baby's brain and is a cosmetic condition.

It is very important that if your baby has difficulty turning to either side or tightening of any muscles in their neck that you see your G.P. or Health Visitor for further advice.

How can plagiocephaly/ brachycephaly be avoided?

  • To reduce the risk of cot death, babies should always sleep on their backs. When your baby is awake, however, you should play with your baby in a variety of position i.e. with your baby lying on either side and on his/her tummy. This avoids the constant pressure on the back of the head and allows for the development of the natural head shape. Babies like to play in a variety of positions and to practise lifting their head when on their tummy.
  • Always supervise your baby when they are playing on their tummy. NEVER let your baby fall asleep on their tummy.
  • It is recommended that you change the way your baby's head turns when they are sleeping by gently turning their head so they are not always lying on the same part of their skull.
  • Young babies should only be in car seats when travelling and should spend limited time in bouncy seats which will also cause pressure on the backs of their heads.
  • Young babies should have regular position changes throughout the day to avoid constant pressure on the back of their head.

What should I do if my baby's head seems flat?

Most cases of positional plagiocephaly/ brachycephaly can be avoided with the above positional advice. (It is normal for babies' heads to be slightly flatter at the back or on one side.) However, if you are concerned that your baby is developing a more noticeable 'flattened' head then the current treatment is the same as the repositioning advice given above. You should also reposition your baby's head away from the flattened side after he/she has gone to sleep.

However, if you are at all concerned about the shape of your baby's head then you should consult with your Health Visitor or GP for further advice.


There has been much discussion recently over the use of helmets for severe flattening of the head. There is a lack of data from controlled clinical trials to currently support the use of helmet treatment. As a result, this treatment is not recommended or generally available on the NHS in Scotland. This fact sheet will be updated should new information come to light.

Further information

Further information for parents and NHS staff can be found at:

Ready Steady Baby!

Information about plagiocephaly can be found at Ready Steady Baby! on the NHS inform website:

Plagiocephaly | Ready Steady Baby! (

NHS Health Scotland

General information for parents can be found on the website of NHS Health Scotland:

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