Plagiocephaly – Flat Heads and Movement Preferences in Infants


Have you ever noticed a flat spot on your infant’s head? Or maybe you’ve started to see that they only look or roll to one side? Any of these attributes may relate to what is known as “plagiocephaly” (i.e. flattening of the skull).

What is Plagiocephaly?

With the onset of the Safe to Sleep Campaign in 1994, the goal was to reduce the risk of Sudden Infant Death Syndrome (SIDS) – commonly known as “crib death”. This campaign advocated for infants to sleep on their backs (which reduced SIDS by 94%) but led to infants preferentially sleeping on one side of their head – slowly leading to a flat spot (i.e. “plagiocephaly”), as infants don’t have the head control or neck strength to move their head in either direction. Consequently, Pediatric Physiotherapists have seen an increase of plagiocephaly from 1 in 300 to 1 in 50 live births.  Though the numbers may seem daunting, parents should take comfort in the fact that Paediatric Physiotherapists see one in two infants with this condition – and simple treatments have been proven to be most effective in the first six months of life!


What Does Plagiocephaly Look Like?

If you are querying whether your infant may have plagiocephaly, watch for these common indicators:

  • Your infant has a flat spot on their head (either on one side, or the entire back of the head);
  • Your infant mostly looks to one side;
  • Your infant tilts their head to one side in sitting; and/or
  • Your infant has difficulty breastfeeding on one side;
  • You may see other assymetries as well – one ear may appear higher, or the jaw or cheeks might not look the same.

If any of these apply to your infant, simply inform your family doctor (to do a quick screen) or simply self-refer yourself to a Paediatric Physiotherapists.


What Can I Do at Home in the Meantime?

Since infants sleep so much in the first few months (and do so mainly on their backs), you may want to position them slightly over their opposite side to get the pressure off the side of the head that’s flat. Additionally, you want to counteract this position by getting lots of tummy time! Not only does this get infants from laying on the back of their heads but it also activates the muscles at the back of the skull which play a role in shaping it (thus reducing plagiocephaly). This can be simply playing on the floor, or placing your infant on your chest so they are looking up at you – this not only achieves tummy time but also initiates bonding with your infant!

The current standard is to get 60 minutes of tummy time per day – which can and should be done in many shorter windows of time.

Early Intervention is Best! How Physiotherapy can help your infant with Plagiocephaly.

We understand that knowing your child may present with plagiocephaly can be distressing to you as a parent. Butterfly Physiotherapists are trained in infant conditions and can provide you with the support and education you need to answer any questions you may have, allow you to take an active role in recovery, and be confident that your child is in good hands. We look at the child and family as a whole, and combine education and treatment about the specific issue with important early intervention to ensure gross motor milestones are not being compromised. In a typical session with a Physiotherapist, therapy would include: education on how to position your infant for sleep and feeding, tummy time positions, as well as hands-on techniques by the therapist.  Physiotherapists can also make recommendations regarding pillows, slings, and if warranted, referrals to other health care professionals like orthotists.

Early intervention is important, so don’t wait!

Give us a shout at Butterfly if you are looking for hands-on physiotherapy to help! (905) 206 – 0300.