Plagiocephaly: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Plagiocephaly?
A pediatrician, a doctor who cares for babies and children, usually checks a baby's head shape. A pediatric physical therapist, a neurosurgeon (a brain and skull surgeon), or a pediatric plastic surgeon may help with harder cases. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is plagiocephaly?
Plagiocephaly means a head that is uneven in shape because one side is flattened. There are two kinds. Positional plagiocephaly is much more common. It happens when outside pressure shapes a normal, soft skull. The other kind is caused by craniosynostosis, a problem where the seams between skull bones close too early.
A positional flat head does not affect brain growth or intellectual development. It changes how the head looks, and most cases do not need surgery.
Symptoms
The main sign is a flat spot on a baby's head. Look for these changes:
- The back of the head is flat on one side.
- The forehead may stick out more on one side, so the head looks like a parallelogram, a slanted four-sided shape.
- The ear on the flat side may sit farther forward.
A positional flat head tends to improve as a baby gains head control. A flat head caused by craniosynostosis gets worse over time.
Causes and who gets it
A baby's skull has soft, bony plates that have not joined yet. The plates can move a little, which helps the head pass through the birth canal. Common causes include:
- A preferred head position. Some babies like to sit or sleep with the head turned one way.
- Not enough tummy time while awake and watched.
- Being a twin or triplet, because of cramped positions in the womb.
- Being born early. Preemies lie flat on their backs in the hospital and have softer bones.
- Birth complications, such as forceps, vacuum delivery, or a difficult labor.
- Torticollis, a condition where the neck muscles are tight or uneven.
An estimated 85% of babies with torticollis also have a positional skull deformity.
How doctors diagnose it
Your pediatrician can tell whether a baby's head shape comes from positional flattening or from craniosynostosis, which is uncommon but more serious. The doctor looks at the head shape and asks about the baby's usual sleep position.
If craniosynostosis is a worry, a doctor may order a CT scan, which takes detailed 3D pictures of the skull. It can show whether the seams between the skull bones have closed too early.
Treatment
The best treatment is prevention. If a flat spot is found early, simple changes in position help. For example:
- Limit time in a car seat, bouncy seat, swing, or other carrier. These put pressure on the back of the head.
- Give more supervised tummy time while your baby is awake. Start with short spurts and slowly work up to an hour a day in several short sessions.
- Switch arms when you hold and feed your baby.
- Change which end of the crib you place your baby down for sleep.
For moderate or severe flattening, a pediatric physical therapist can check for tight neck muscles and teach stretching and positioning exercises to do at home. If flattening is moderate or severe and does not improve by 5 or 6 months of age, a molding helmet may help. A specialist fits the helmet. Side effects can include skin irritation and pressure sores.
Surgery for a positional flat head should only be considered when all other options have been tried, and only after talking with a neurosurgeon or pediatric plastic surgeon. Craniosynostosis is different. It needs surgery.
Do not use head-shaping pillows. They are not safe for babies and may raise the risk of suffocation. The FDA says there is no evidence that they work.
When to see a doctor
Talk with your pediatrician if you notice changes in your baby's head shape or have any concerns. Have a doctor check your baby if a misshapen head comes with a bulging soft spot. This can be a sign of too much pressure inside the skull when skull bones close early, though it is often missing.
Call 911 or go to the emergency room if your baby is much sleepier than usual, is hard to wake, is not alert, has severe vomiting, or has a seizure or trouble breathing.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can look at your baby's head shape, review sleep and feeding positions, and refer you to a pediatric specialist when needed.
Common questions
Does a flat head hurt a baby's brain?
No, a positional flat head does not affect brain growth or intellectual development.
Will a flat head get better?
Often yes, but it depends. Positional flattening tends to improve as a baby gains head control. Starting simple treatment early gives good results, because an infant's skull is soft and can reshape.
Does my baby need a helmet?
Not always. A helmet is for moderate or severe flattening that does not improve with position changes by 5 or 6 months of age.
Are head-shaping pillows for babies safe?
No, head-shaping pillows are not safe for babies. They can create an unsafe sleep space and may raise the risk of suffocation. The FDA says there is no evidence that they help.
Sources
- HealthyChildren.org (American Academy of Pediatrics) - When a Baby's Head is Misshapen: Positional Skull Deformities
- StatPearls (NCBI Bookshelf) - Plagiocephaly
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
