Features / 22 September, 2017 / Simone Ross

Flat Head Syndrome – To Treat or Not to Treat?

My Baba’s resident expert osteopath Simone Ross talks to us about the rise in the number of babies with flat head syndrome, and what we as parents need to look out for, and when the condition needs to be treated.

In the last 10 years the advice has been to lie our babies on their backs to sleep. Reports suggest this has reduced the number of cot deaths by 40%. However, while we have been sleeping our babies on their backs, another problem has arisen: the increasing prevalence of Flat Head Syndrome, also known as plagiocephaly .

In 1974 only one in 300 children had flat head syndrome. Now the figures show it has risen to over 20% of babies. Although not all of these babies will continue to have flat head syndrome, some will and this will not go away even in adulthood.

All babies have a soft skull so if they lie in the same position they will get flat. The more pressure on the one particular area, the flatter that area will become. Once your baby has a flat spot on their head they will naturally lie on the flat spot. This unfortunately increases the flatness.

How to tell if there is a problem?

Assess your own baby

  • Does your baby have flatness developing on his head or a tilt or both?
  • Is your baby always sleeping to the same side?
  • Does your baby favour one breast?
  • Does your baby lie with its head to both sides comfortably when on his tummy?
  • Is your baby tongue tied?
  • Does your baby move both shoulders/arms equally?

When your baby is born, look at your baby’s head. If it is particularly flat on one side, feeds off one breast better than the other, or always sleeps to one side, then get your baby assessed as soon as possible – a problem is easier to correct before your baby is 6 weeks old.

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Torticollis is restriction of the sternocleidomastoid muscle in the neck. This muscle side bends the neck to one side and rotates the neck to the opposite side. In these cases your baby’s head often looks tilted to the side as well as rotated.

The flattening for a baby with torticollis will develop on the opposite side. The head often looks tilted and there can be restriction of the shoulder joint on the side of the restricted sternocleidomastoid muscle.

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Is this important? Plagiocephaly is sometimes argued to be purely a cosmetic issue. Of course, for many of us parents that is an important issue itself. Babies with flat heads at the back get frontal bossing and lower protruding ears. Those babies with flatness developing on one side can get some asymmetry through the face, ears and maybe restricted in their neck movement.

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High risk babies include

  • Bigger first babies
  • Babies with positional preference when sleeping and awake
  • Mothers who carried low and always in the same position
  • Multiple birth
  • Breech babies whose heads are tucked under the mother’s ribs
  • Babies who do not like tummy time
  • Babies who favour one breast


Tummy time is essential for all babies. If your baby has a flat head when it is lying on its back, it will always tend to roll to the flat spot. Tummy time not only takes the pressure away from the flat area but it also strengthens the neck. Babies who lie on their tummies are also more likely to reach their milestones of sitting, walking and crawling more quickly.

To put your baby on its tummy it should be awake and supervised.

When positioning, turn your babies heads to both sides. Use pillows on the floor or hard surfaces. In your baby’s bed, specialised pillows and mattresses are available for babies with flat heads. Stimulate your baby from the side they do not want to face. Do not leave your baby in car seats or bouncy seats for long periods of time. If you are having feeding or colic problems check to see if the baby is tongue tied as some babies with torticollis also have a tongue tie.

You can try and reposition your baby but if they are still turning to the same side after a couple of weeks you should bring your baby to an osteopath to be assessed. It is much easier to prevent the problem developing rather than cure it. Your baby will need a lot less treatment if the baby is seen earlier rather than later.

Osteopathic treatment at Kane and Ross Clinics aims to increase the range of movement of your baby’s cervical spine as quickly as possible which prevents the baby lying on the same spot and so prevents further flattening. A specific exercise programme will be given to your baby and postural advice will be given for you to do at home. You can self refer into the clinic or we have many referrals from paediatricians, GPs and midwives for babies with restricted cervical spine problems who are developing flat heads and feeding problems.

We have published a booklet for parents on advice for babies with Flat Head Syndrome. If you would like a copy please call the practice on 020 7436 9007.

Simone Ross has practiced osteopathy for 15 years and runs Kane and Ross clinics in Harley Street and Courtfield Gardens, Kensington. Simone has previously worked in central London hospitals seeing post-natal mothers and newborns and teaches other osteopaths, midwives and doctors about osteopathic treatment. Simone specialises in treating babies and children with conditions such as colic, plagiocephaly, unsettled babies and lactation issues. She also has four children of her own.

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