Positional plagiocephaly — a flat spot on one side or the back of a baby's head — is one of the most common concerns parents raise with paediatricians. It has increased significantly since the Back to Sleep campaign began, because babies now spend much more time on their backs. In India, the practice of keeping babies on firm surfaces and the tradition of oil massage actually provide some protection, but flat head syndrome is still common.
Why It Happens
A newborn's skull is soft and malleable — designed to compress through the birth canal and then expand. This flexibility also means that consistent pressure on one area can flatten it. The most common cause is spending extended time in one position: always sleeping with the head turned to the same side, spending long periods in car seats, bouncers, or swings, and not having enough tummy time.
Prevention
Tummy time — this is the most effective preventive measure. Supervised tummy time when baby is awake and alert, aiming for 30 minutes total per day from birth, prevents the back-of-head flattening and builds neck and core strength. Most babies dislike tummy time initially — start with very short sessions (2 to 3 minutes) and increase gradually.
Alternate head position during sleep — in the early weeks, alternately position your baby's head to the left and right when laying them down. If they consistently prefer one side, gently encourage turning to the other side during awake time and reposition during early sleep.
Limit time in carriers and seats — car seats, bouncers, and swings all apply pressure to the back of the head. Use them when needed but prioritise arms, floor time, and tummy time for most of the day.
When to See a Doctor
If you notice a significant flat spot, restricted neck movement (your baby strongly prefers looking one way — this is called torticollis and needs physiotherapy), or the flat spot is not improving with repositioning by 4 to 5 months, see your paediatrician. For severe cases, a cranial remoulding helmet (available in Indian cities) worn for 23 hours a day during the period of skull growth (before 12 months) can be effective.