The push to put babies to sleep on their back to reduce the risk of sudden infant death syndrome (SIDS) has been associated with a decrease in the incidence of SIDS but has led to an increase in the number of babies living with head shape abnormalities. However, positional skull deformities are generally benign, reversible head-shape anomalies that do not require surgical intervention, as opposed to craniosynostosis, which can result in neurological damage and progressive craniofacial distortion. Although associated with some risk of positional skull deformity, healthy young infants should be placed down for sleep on their backs.

Parents are naturally concerned if they observe asymmetry or unusual flat spots on their baby’s head and abnormalities in the face, and often seek advice from their paediatrician. These concerns are valid and assessments need to include not only the back, but forehead flattening, ear shift, and orbital or facial involvement.
This guide is designed to provide information about the causes, signs and treatment strategies for managing head shape deformities in infants. This includes educating parents on methods of proactively decreasing the likelihood of the development of occipital flattening, initiating appropriate management and making referrals when necessary.

Treatment interventions include repositioning, a developmental home program, paediatric physiotherapy for patients with torticollis and the use of a cranial remolding orthosis to improve symmetry and normal proportion.

Why are the skulls of infants subject to deformation?

  • The plasticity of the newborn’s skull makes it susceptible to external pressures in the womb, during the birth process and after birth
  • The immobility of newborns and any positional neck preference can predispose infants to extrinsic skull deformities
  • Intrinsic abnormalities can be caused by craniosynostosis or through genetic transmission
  • Deformational forces most frequently affect the occiput, although the frontal bones and the face may be affected in severe cases
  • About 24%* of babies have some type of noticeable skull deformity at birth, reducing to about 20%† by four months of age
  • The abnormal shape may persist or occur if the baby spends most of the day on the back against the hard surface of infant carriers and holding devices

What are contributing risk factors for head deformation?

  • Prolonged exposure to the supine position
  • Lack of time on the tummy when the baby is awake
  • Congenital muscular torticollis, neck weakness or restricted neck range of motion
  • Males more frequently develop deformational plagiocephaly at a rate of 2:1
  • Slower motor development particularly in gross motor skills
  • Breech or transverse presentation
  • Multiple birth infants
  • Visual field deficits
  • Bony abnormality in the cervical spine

What are the types of deformational head shapes?


  • The most common type of skull deformity in infants
  • Normally noticed by caregivers at about six to 10 weeks of age
  • Characterised by an asymmetrical skull shape
  • Unilateral occipital flattening
  • Ear is positioned more anterior on the side of the occipital flattening
  • Forehead may be asymmetrical and is positioned more anterior on the side of the occipital flattening
  • Facial asymmetry may be present
  • May be accompanied by torticollis, limited neck range of motion, weakness and preferential head positioning

Information based on research from MEDICLINIC