Infants
22 November, 2025
Many parents notice flat spots on their baby’s head in the first few months of life. This is called plagiocephaly.
Plagiocephaly is the result of a baby lying with their head turned predominately to one side. The infant skull is soft and the increased pressure on one side results in a flattening on that side and a ‘bump’ on the other side. Where the flattening is significant it can affect the symmetry of your baby’s face.
Flat spots can usually be improved significantly through the implementation of a 24-hour “counter-positioning” program. This involves encouraging your baby to look to the non-preferred side whenever able, while always following the SIDS guidelines (https://rednose.org.au/section/safe-sleeping).
Some useful strategies include:
-Placing your baby in tummy time when awake and supervised
-Lying you baby on their non-preferred side when awake and supervised; you may need to use some rolled up towels to help your baby stay on their side or you can cuddle them against you
-Placing toys and interesting objects including baby play arches with dangling toys on the non-preferred side
-Rearranging their sleeping environment so the most interesting object for them to look at is on their non-preferred side e.g. if you baby sleeps in their cot beside your bed and you are on their preferred side, putting their head at the other end of the cot may encourage them to turn their head
Head shape can improve significantly once babies are no longer lying on the preferred side too often. The most rapid improvement occurs between 4 and 8 months of age however improvement can be seen up to 2 years of age. And remember, if any mild flat spot is left, hair will often help cover this up.
Most babies with mild flat spots do not require a physiotherapy review. Times when you should seek a physiotherapy review include:
-if your baby’s head appears tilted to the side
-if your baby is unable to turn their head fully to the non-preferred side.
In these instances, your child may have a a condition known as torticollis which requires physiotherapy management including stretches and strengthening exercises.
Head shape can improve significantly once babies are no longer lying on the preferred side too often. The most rapid improvement occurs between 4 and 8 months of age however improvement can be seen up to 2 years of age.
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