Q&A with Dr. Jane Scott


Q: How do flat spots develop?

A: From ages 0-6 months, babies’ brains are growing very rapidly—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 terms related to flat head syndrome. Babies’ skull shapes can also become asymmetrical from birthing issues, pregnancy problems, and congenital abnormalities.

Q. What Should I be concerned about Flat Head Syndrome?

A. Because one in three healthy babies will develop some degree of flat head syndrome after birth. All babies are at risk. And it’s even more common with multiple or premature births. But it’s preventable.

Q. Is this new? Why haven’t I heard of it?

A. Flat Head Syndrome has 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%.

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.

Q. Can this affect my baby’s developmental progress?

A. 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)


Q. Will this cause permanent problems for my baby?

A. 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.

Q. How Can I Prevent Flat Head Syndrome?

A. 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 be flat on their backs when they are. To reduce the pressure this can cause on the back the head, you should change your baby’s head positioning after each feeding, alternating sides so that one does not become favored.


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 strong enough to move on her own, you can provide distractions to entice her to alternate sides, perhaps putting a favorite toy on her less favored side. Another helpful tactic can be to turn her around in the crib so that she naturally turns toward the parent and the activity in the room.

Q. What If My Baby has Flat Head Syndrome?

A. Once positional plagiocephaly/brachycephaly (or flat spots) 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.


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

Q. What About Tummy Time?

A. 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 everday for optimal prevention.

Q. What About Helmets?

A. 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.

Q. How Soon Should I Act?

A. 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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