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Q&A with Dr. Jane Scott


  • How do flat spots develop?

    From ages 0-6 months, babies’ brains are growing more than they ever will—and their skulls need to be soft enough to accommodate this growth. The problem? When newborns and young infants spend too much time on their backs, in one position, flat spots can develop. Positional plagiocephaly, brachycephaly, and torticollis are the medical term for Flat Head Syndrome. Babies’ skull shapes can also become asymmetrical from birthing issues, pregnancy problems, and congenital abnormalities.

  • Why should I be concerned about Flat head Syndrome?

    Flat Head Syndrome in Baby | TortleBecause one in two healthy babies are currently developing some degree of Flat Head Syndrome after birth. All babies are at risk, despite whether they come into the world via a c-section or vaginal birth. And Flat Head Syndrome is even more common with multiple or premature births.

  • Is this a new problem for infants? Why haven't I heard of it?

    Positional plagiocephaly and brachycephaly have increased 600% in the last twenty years. Current medical thinking points to two lifestyle changes as the cause:

    1) In 1992, the American Academy of Pediatrics began its “Back to Sleep” program to reduce Sudden Infant Death Syndrome (SIDS). And it worked: the incidence of SIDS has plummeted by almost 40%. However, this led to babies spending more time than ever on their backs, which directly contributes to the development of flat spots.

    2) Infants are being placed in reclining carrying devices more than ever. Families on-the-go keep their babies in carriers, car seats, and swings for an extended time—frequently up to 15-18 hours per day.

Effects of Flat Head Syndrome

  • Can this affect my baby's developmental process?

    Yes. There are studies that show intellectual differences between children with plagiocephaly and those without. One study demonstrated that 39% of children with persistent deformational plagiocephaly received special educational services versus 7.7% of their siblings. (Pediatrics 200,;105:e26)

  • Will this cause permanent problems for my baby?

    Flat Head Syndrome typically occurs within the first few months of life, but the effects of skull deformation can be permanent. Beyond the cosmetic issues, there can be trouble with binocular vision and long-term developmental issues. This is why it’s so vital to prevent Flat Head Syndrome from occurring in the first place and to treat it as soon as it develops.


  • How can I prevent Flat Head Syndrome?

    The best method of prevention is to be diligent in repositioning your baby’s head. Newborn infants sleep the majority of the time, and it’s important that they are flat on their backs when they do. Due to the constant pressure on the back of the head, Flat Head Syndrome can develop.

    To reduce the pressure, you should:

    • Change your baby’s head positioning after each feeding, alternating sides so that your baby doesn’t come to favor one side
    • Alternate the arm in which you hold your baby for feeding, and alternate the side from which you approach her during diaper changes
    • As your baby gets older and becomes strong enough to move on her own, you can provide distractions to entice her to alternate sides, perhaps by putting a favorite toy on her less favored side
    • Turn your baby around in the crib, so that she naturally turns toward the parent and the activity in the room


  • What if my baby has flat head syndrome?

    Once Flat Head Syndrome has been diagnosed, most physicians recommend repositional therapy. This involves positioning your baby to avoid putting pressure on the flattened areas. But in practice, repositioning can be difficult, as babies often automatically revert to their preferred side. This is why we created the Tortle, which keep your baby’s head active and takes pressure off these flat spots.

    If your baby has been diagnosed and it’s beyond the window to try repositional therapy, there is a high rate of success with physical therapy treatment, and in more severe cases, a custom helmet. See your doctor and a physical therapy specialist for more information.


    Tummy time—supervised time with your baby lying on her belly—can help prevent Flat Head Syndrome, strengthen your baby’s developing muscles, and promote certain motor skills. It’s a good practice to start right after birth; the earlier your baby gets used to tummy time, the less fussy she’ll be.

    Although tummy time is an important part of early childhood development, it’s hard work for your baby, and her crying and fussing may force you to limit its time—and thus its effectiveness.

    So in addition to tummy time, we recommend Tortle Time! Wearing Tortle whenever baby’s head is resting in car seat, stroller, bouncer, floor, or supervised sleep can help encourage baby to avoid Flat Head Syndrome. Practice Tortle Time and Tummy Time every day for optimal prevention.


    If this repositional therapy is ineffective, a physician may recommend cranial orthotic therapy—a custom-fitted band or helmet, which costs thousands, and may not be covered by insurance. And even those cannot guarantee a successful result.


    Many infants already have the problem by two months of age, and all premature infants with prolonged hospital stays are at risk. Practicing good head positioning through early infancy is critical for prevention.

    By the end of the first year, a baby’s skull has hardened, and most therapies have little effect after this time. That’s why prevention is key.

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