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Flat Head and Physiotherapy

Does your little one’s head look more flat on one side or is one ear a bit more forward than the other? Your baby might have cranial asymmetry also known as Plagiocephaly (Flat Head) and physiotherapy can help!

What is Plagiocephaly?

Plagiocephaly is when a portion of the skull’s shape is changed due to the forces from the surface they are laying on, mostly when they are on their back. It is most prevalent at 6 weeks of age (Cummings 2011) and the risk increases if a baby has torticollis (a muscle in the baby’s neck is tighter or weaker on one side so they have a head tilt or turn preference).

What can all new parents do to help prevent plagiocephaly?

Tummy Time when baby is awake

  • Guidelines recommend tummy time 3 times per day for 10-15 min (Cummings 2011). Tummy time does not have to mean baby is on the floor, they can be on you, chest to chest and progress your position from sitting up to reclined to laying down. Different ideas for tummy time options can be discussed at your physiotherapy session.


  • In crib or bassinet - Baby will usually rotate towards the light, a noise or smell (parent) so if the bassinet is beside parent, baby will have a tendency to rotate their head towards that side creating a flat spot on the same side. Try rotating baby so head is at different ends of bassinet to encourage rotation in both directions.

  • Being held – when bottle feeding, if you always hold baby in your left arm and hold bottle on your right, baby’s back/right side of head may become more flat. Try alternating arms if you are comfortable.

When can physiotherapy help?

If a baby has torticollis, the physiotherapist can provide specific exercises to strengthen the weak side of their neck or stretch out the tight side. By correcting this, the baby will actively move their head around to either side when awake which will help ease pressures placed on the skull. If the torticollis is not addressed then plagiocephaly is more likely to occur.

Physiotherapy assessments for torticollis and plagiocephaly can occur as early as 4-6 weeks. If positional preference is identified early (before 8 weeks) then studies show physiotherapy can reduce the incidence of severe plagiocephaly by 6 months of age (Vargish et al. 2009).

Does my baby need a helmet?

Evidence suggests re-positional therapy is the treatment of choice for mild to moderate plagiocephaly and most cases resolve by 2 years of age. Helmet therapy is typically used with more severe cases and is introduced by 8 months of age (Cummings 2011).

As a parent, especially first time parents, there is so much to learn and think about as you want to do everything you can to do what’s best for your baby. With the internet and social media, there is so much out there which may lead you down different paths and may lead to more questions. We recommend if you have concerns about your baby’s head shape or neck movements, please consult your family physician or paediatrician first. Please continue to use “back to sleep” guidelines for supine sleeping as it does reduce incidence of sudden infant death syndrome.

Written by: Lindsey Haussler, Registered Physiotherapist



  1. Carl Cummings; Canadian Paediatric Society, Community Paediatrics Committee

Paediatric Child Health 2011;16 (8):493-94

  1. Vargish L, Mendoza MD., Ewigman B., Hickner J. Use physical therapy to head off his deformity in infants. Journal of Family Medicine. 2009 Aug; 58 (8): E1-E3.

  1. Video/Exercises courtesy of Physiotec


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