Brachycephaly in babies: signs, causes and management options

As a parent, noticing a flat area on the back of your baby’s head can be concerning. This condition, known as brachycephaly, is relatively common and often corrects itself with time and care. However, in some cases, head shape differences can persist if the flattening does not improve during the main period of skull growth.

What is brachycephaly?

Brachycephaly is a condition where the back of a baby’s head becomes flattened, resulting in a wider head shape. This flattening typically occurs when a baby spends extended periods lying on their back, causing consistent pressure on the same area of the skull. While brachycephaly is often considered a cosmetic issue, it is still important to monitor head shape and seek advice if you have concerns.

Causes of brachycephaly

Several factors can contribute to the development of brachycephaly:

• prolonged supine positioning: Babies spending extended periods lying on their backs without variation can develop flat spots
• limited tummy time: Insufficient supervised time on the stomach reduces opportunities to relieve pressure on the back of the head
• infants with colic, reflux or chronic congestion: Inclined sleeping can influence the head to grow vertically
• Torticollis: A condition where tight neck muscles limit head movement, causing a baby to favour one side
• premature birth: Premature infants have softer skulls and may spend more time lying down, increasing the risk
• multiple births: Twins or triplets may have restricted movement in the womb, leading to head shape irregularities

Read George and Albert’s brachycephaly story here.

When brachycephaly may need extra support

Many cases of brachycephaly are mild and improve with time, repositioning and your baby’s natural growth. In more noticeable cases, head shape differences can persist if the flattening does not improve during the main period of skull growth.

Some families choose cranial helmet treatment because they are concerned about:

• head shape remaining uneven over time
• forehead or back-of-head shape becoming more noticeable as growth continues
• practical or emotional impact as a child gets older (this varies from person to person)

Some research has explored links between more noticeable head shape flattening and developmental differences. This does not mean brachycephaly causes developmental delay. If you have any concerns about your baby’s development, it is best to speak with your GP, health visitor or paediatric team.

Signs you might notice

Noticing changes early can help you get the right advice and support. Parents and caregivers should look for:

• flattening at the back of the head: A noticeable flat area, especially when viewed from above or the side.
• widened head shape: The head appears shorter from front to back and wider from side to side.
• bulging forehead: The forehead may protrude more than usual.

If you notice any of these signs, it’s a good idea to speak with a healthcare professional for expert advice. You can also use our free flat head photo assessment form to submit photos of your baby’s head. A member of our orthotics team will respond with guidance on possible next steps, including whether an in-person orthotic assessment may be helpful. This does not replace assessment or diagnosis from a medical professional.

If you’re concerned about your baby’s head shape, we offer complimentary in-person consultations for babies aged three months and older. During this appointment, we will carry out a 3D head shape assessment and take measurements. We use these measurements to understand head shape symmetry and, where appropriate, to plan orthotic management such as helmet therapy. If there are any concerns that need medical assessment (for example, suspected craniosynostosis), we will advise you to speak with your GP or paediatric team. We do not provide medical diagnoses.

Management options

Starting support early can be helpful during the main period of skull growth.

Options may include:

Repositioning techniques

Encouraging varied head positions can alleviate pressure on the flattened area:

• alternate head positions during sleep: Gently turn your baby’s head to the sides when placing them to sleep.
• increase tummy time: Supervised time on the stomach strengthens neck muscles and reduces pressure on the back of the head.
• limit time in car seats: Reduce prolonged periods in seats that restrict movement and encourage your baby to lay on the back of the head.

Read our guide to repositioning for more detail

2. Physical therapy or cranial osteopathy

If your baby has torticollis, a physiotherapist can help with assessment and exercises to support neck movement and positioning by providing:

• stretching exercises: Targeted movements to improve neck muscle flexibility.
• strengthening activities: Exercises to enhance neck and shoulder strength, promoting balanced head movement.

3. Cranial remoulding orthoses (helmet therapy)

For more noticeable cases, or where repositioning has not led to enough change:

• custom-fitted helmets: Designed to gently guide skull growth into a more typical shape.
• optimal age for treatment: Most effective when started between 4 to 7 months of age, as the skull is more malleable.

At the London Orthotic Consultancy, we offer bespoke cranial remoulding orthoses tailored to your baby’s needs. Learn more about our orthotic treatment options.

Prognosis and long-term outlook

Head shape often improves over time, particularly when repositioning starts early. Where helmet therapy is recommended, many families see measurable changes during treatment. Results vary depending on age, severity and daily wear time.

Contact us to speak with a member of our orthotics team or to arrange an assessment. No referral is needed. If you have concerns about your baby’s health or development, speak with your GP, health visitor or paediatric team.