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What's Wrong With A Flat Head?

Updated: Feb 26, 2021

A “Cosmetic Problem” That Has Functional and Early Motor Learning Implications

So why do we recommend helmets? What makes them important and why should plagiocephaly be treated? Are there lasting effects from untreated plagiocephaly?

Many people believe that helmets are a quick fix for a purely cosmetic issue of a head that looks flat (bust the stigma.) Beyond cosmetic aesthetics, plagiocephaly can have a significant impact your baby’s development and lasting effects on motor learning, visual processing and sensory processing centers. Up until recently, most studies have only correlated plagiocephaly with developmental delays however there is recent research that attributes specific conditions directly to plagiocephaly.

Remember, plagiocephaly is not new. Cranial asymmetries and torticollis have been described for centuries! Plagiocephaly is more common now than ever before due to placing babies on their backs for sleep and in carriers for transport. The increase in plagiocephaly can also be attributed to the growing number of babies that survive and thrive after premature birth; their early development in a NICU isolet can make it difficult to escape plagiocephaly. With this rise in occurrence we are now able to fully study and appreciate the lasting effects of untreated plagiocephaly.

Plagiocephaly is usually a symptom of something else and should be taken seriously! Plagiocephaly is a physical manifestation of something that is asymmetrically happening with your baby. It could be that they are simply preferring to look at a specific light in their room on one side. It might be that your child has a lip tie and prefers to eat a certain way. There are also cases where severe reflux contribute to plagiocephaly. We know that plagiocephaly is an early indicator of something.

The Missing Link with Developmental Delay

The research studies surrounding cranial remolding helmets and plagiocephaly are slowly increasing in popularity and all look at a slightly different aspects. Many of the studies look at the developmental progression of the child for a few years following a diagnosis of plagiocephaly and/or brachycephaly. The research concluded that continued plagiocephaly may be an indicator that the child may have a developmental delay or scholastic difficulty in the future.

There isn’t enough evidence to say that a lasting, mis-shaped head causes these learning difficulties, but it may be an early indicator that the child has an emerging delay. We do know that plagiocephaly and brachycephaly are caused by less symmetrical movement off of the back of the head. Early motor learning is what lays the foundation for scholastic success. If motor learning is interrupted by restricted movement or a side preference this could be cause for future developmental difficulty.

While the helmet is not a direct fix for a possibly underlying issue, it does pair nicely with therapy. That's because the helmet is round in the back and allows the child to more easily move off of the flat spot to explore their environment, which allows motor learning and the typical progression of development to occur! It also blocks the peripheral view and encourages baby to look around, strengthening their neck muscles. What we know from experience is that the helmet seems to allow babies the advantage of moving from a round back of their head before the actual head rounds out.

Torticollis & Occular (Visual) Torticollis

Babies can develop plagiocephaly if they have a side preference. If your baby is unable to move away from this preferred position due to tightening of the neck muscles they have torticollis. Toticollis has a variety of underlying causes, from tongue ties to reflux or inutero positioning. Torticollis makes it even more difficult to turn their head in the opposite direction and contributes to plagiocephaly. When torticollis is a contributing factor to plagiocephaly, it is necessary to treat both the torticollis and the plagiocephaly.

The same thing happens in the eyes- the muscles get tighter on one side due to the baby having a consistently tilted head position from a side preference. The head is no longer in midline so the eyes are consistently having to adjust and can get tight on one side. With occular torticollis, there is no true neck involvement of a tightened muscle. It is the eye muscles that need to be retrained to know where a middle, resting posture is.

When we use a helmet to fix plagiocephaly, it makes it easier for baby to turn their head because they’re not sitting in a flat spot. We also have positioning techniques we love to recommend and stretches we can show you during your appointment.

Direct Problems From Facial Shift When there is an asymmetry in the back of the baby’s head, there is a chance that there can also be a facial shift.

A facial shift can also result from torticollis or a restriction in neck movement due to tightening in the neck muscles. This can cause the head to be stuck in one position, unable to turn both directions. In severe cases, this position can push the jaw laterally, off to the side. This can create a facial shift and head shift that we refer to as “windswept” and is a very severe involvement of the facial bones that is difficult to describe on the cranial vault asymmetry scale.

A facial asymmetry can affect the eyes, ears, and/or jaw, and may be an indicator of future concerns/issues. Some of these developmental concerns include astigmatism, visual field deficits, ear infections, hearing problems, deviated septum, jaw malalignment, and lateral crossbite. (See references)

A helmet can correct plagiocephaly in both the front and back of the head! It makes contact with the front and back where it is pushed out and then allows room for the rest of the head to grow into the mold where there is flattening. With severe cheek shifting we will add a “cheekpiece” to the helmet. This is an innovative technique we conceptualized and brought into practice through the help of our manufacturer Orthomerica. The cheekpiece helps address facial asymmetry first. We then continue to measure progress with the StarScanner and cut the cheek piece off once our goals are met.

Self-Confidence for Your Child

We love our children no matter what they look like, how they dress, or what types of activities they like to play. We as adults know that we have the freedom to be ourselves and do the things that make us happy because the people who care about us will love us no matter what.

When kids are in school, they are still trying to develop their personality and identity, and the feeling of needing to ‘fit in’ is on their minds a lot. Social media is a big contributor to this because people will say things behind a screen that they wouldn’t say in real life. Research has shown that mental health concerns have grown exponentially in young and adolescent children over recent years.

Do you have a flat or asymmetrical head and were not teased as a kid? That’s wonderful, we just want to address the possibility of bullying because it unfortunately does occur. Reducing your child’s plagiocephaly or brachycephaly while they’re young can make a large impact on their ability to feel more ‘normal’ during their formative years. One study found that children who have had cranial remolding helmets are less likely to be teased for their head shape than children who still present with plagiocephaly (see resources). If your child has really short hair, wants to wear pigtails, or may go bald in the future, their head shape is going to be seen very clearly.

Sports/ Protective Helmets

Lets talk about your baby’s future!

We have no way of knowing what our little ones will want to be when they grow up or if they’ll want to play sports at some point. What we do know is that many fun activities in life require protective helmets (bike riding, football, hockey, baseball/softball, horseback riding, rock climbing, motocross, water sports, skiing/ snowboarding, etc.). Many careers also require helmets (firemen and women, military, construction related jobs, manufacturing, etc.). These fun activities and careers require helmets for one main reason: to protect the head from blunt trauma and concussions.

Off the shelf helmets are made for a ‘typical’ head shape, so if the individual wearing it has plagiocephaly or brachycephaly, it can make it difficult for the helmet to fit correctly. Ill-fitting protective helmets contribute to an increase in severity of the concussion.

Having taken multiple sports injury classes, concussion trainings, and working alongside athletes, we have seen first-hand the impact that just one serious concussion can have on a person. If we can do something now that will better protect them for their entire life, shouldn’t we? Protective helmets are required for a reason, but they’re not made custom for the individual wearing them. Making your baby’s head more symmetrical and ‘typically shaped’ will allow them to better fit in a protective helmet.

This still may seem like a far fetched scenario for some readers that are thinking “how much difference can it really make for my child to have plagiocephaly in a sports helmet?” Well, we have had many professional athletes bring their children to us for helmets specifically with this factor in mind. They report they want their sons and daughters to have the ability to wear protective helmets because growing up they themselves had helmet fitting issues. Take it from the professionals, the fit of a protective helmet is important!

Helmets decrease caregiver anxiety

Babies bring more than just joy to our lives; they also bring stress, sleepless nights, and a lot of work. Caregivers have so much to worry about and watch for when it comes to developmental progress of baby.

Having a cranial remolding helmet can help take one of the many worries off your list because as long as your baby is wearing their helmet, you don’t have to worry about their eventual head shape! All you have to do is put your baby in the helmet and their head shape can take care of itself. Other tasks surrounding the helmet are things that you’re already doing anyway: checking for redness on their head (babies are too cute not to look at), cleaning the helmet (we disinfect their toys, wash bottles, and have bath time), and monitoring their developmental progress!

We Support Your Reasons

What if you really worry about the cosmetic side of plagiocephaly? WE TOTALLY GET IT. We will never judge you if your reason for wanting to helmet your baby is simply because you prefer your baby to a have a rounder head. It’s your baby and you are entitled to your views and opinions, so don’t ever let anyone tell you otherwise.

We know that it can be scary any time your baby has to go to a doctors office, so we want to make sure you feel comfortable knowing you’ll get all the information you really need about your baby’s little skull. Our practitioners are trained to look for underlying factors for plagiocephaly. We help you start the conversation with your doctor and therapists if you have unaddressed concerns. As always, if you have any questions or concerns about the shape of your baby’s head call us to schedule your complimentary evaluation!


  • Atun-Einy, O., Cohen, D., Samuel, M., & Scher, A. (2013). Season of birth, crawling onset, and motor development in 7-month-old infants. Journal of Reproductive & Infant Psychology, 31(4), 342–351.

  • Collett, B. R., Wallace, E. R., Kartin, D., Cunningham, M. L., & Speltz, M. L. (2019). Cognitive outcomes and positional plagiocephaly. Pediatrics, 143(2), 1–9.

  • Kunz, F., Schweitzer, T., Große, S., Waßmuth, N., Stellzig-Eisenhauer, A., Böhm, H., Meyer-Marcotty, P., & Linz, C. (2019). Head orthosis therapy in positional plagiocephaly: longitudinal 3D-investigation of long-term outcomes, compared with untreated infants and with a control group. European Journal of Orthodontics, 41(1), 29–37.

  • Lee, M. C., Hwang, J., Kim, Y. O., Shim, K. W., Park, E. K., Lew, D. H., & Yun, I. S. (2015). Three-dimensional analysis of cranial and facial asymmetry after helmet therapy for positional plagiocephaly. Child’s Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, 31(7), 1113–1120.

  • Shamji, M. F., Fric-Shamji, E. C., Merchant, P., & Vassilyadi, M. (2012). Cosmetic and cognitive outcomes of positional plagiocephaly treatment. Clinical and Investigative Medicine. Medecine Clinique et Experimentale, 35(5), E266.

Editor Kaitlin Ploeger OTD

© 2023 an Orthopedic Motion Inc. company


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