Cranial Technologies

How to Check for Flat Head Syndrome

What Does a Typical Baby Head Shape Look Like?

To better understand irregularities, let's start with what a typical baby head shape looks like. Here are the general guidelines:

  • The head is 1/3 longer than it is wide
  • The ear canals are in alignment with one another
  • There is no visible asymmetry or disproportion of the facial features

Normal head shapes at 3-9 months old

Normal head shape — 3 months old

Normal head shape — 3 months old

Normal head shape — 6 months old

Normal head shape — 6 months old

Normal head shape — 9 months old

Normal head shape — 9 months old

5 Step to Assess For Signs of Plagiocephaly

Step 1. Check the top of the head

Place your baby in yours or someone else's lap so you have a good view of the top of their head. You may notice flatness on either one side, or the entire back of the head. The head is typically 1/3 longer than it is wide, and if you were to draw a line down the middle, the left half should look the same as the right half.

Head shapes comparing normal to plagiocephaly from above

What to look for

  • Flatness on one side of the head
  • Resembles a parallelogram or trapezoid-like shape
  • Ears are out of alignment with one another
  • Head is wider than it is long
  • Back of the head appears flat rather than curved

Step 2. Check the profile view

Normally, the back of the head is curved and both sides of the head will match both in symmetry and proportion. So for this step, we'll want to focus on the back of the head, and the forehead.

Head shapes comparing normal to plagiocephaly from the profile view

What to look for

  • One side of the head appears more curved than the other
  • The back of the head looks flat
  • The back of the head looks tall with a slope forward

Step 3. Ear alignment test

Typically, asymmetry of the facial features is related to plagiocephaly or is a component of plagiocephaly. The ear alignment test or the Argenta Method is a great way to check for misalignment from a visual standpoint.

Graphic showing how the Argenta test is done

To perform an ear alignment test

  • Hold the baby in your own lap, sitting upright.
  • Gently place your index finger at each of the ear canals (as pictured above).
  • Ensure that you're looking directly down at the head to get a good angle.
  • Observe the alignment of your index fingers across the head (On the x-axis, imagining a line straight across).
  • Look for any misalignment between the index fingers.

However, it's important to keep in mind that flat spots won't always cause asymmetry in the facial features. Therefore the ear alignment test is usually a good indicator for plagiocephaly, but may not always paint the full picture.

Step 4. Check the front of the head

Since you see your baby’s face every day, it can be easy to miss gradual changes to their facial features. Place your baby in front of a mirror, this will make it easier to see asymmetries.

Head shapes comparing normal to plagiocephaly from the frontal view

What to look for

  • One eye is smaller than the other, or one cheek is fuller
  • The head height is not level, or there is sloping
  • Eyes are not level to one another
  • The mouth is asymmetric, or appears "slanted"
  • Head appears wide, and the widest part is just above the ears.
  • Face appears small relative to the size of their head
  • The tips of the ears slant downward

Step 5. Check from below

For the final step, lay your baby flat on his or her back with their face looking directly up toward the ceiling and look up at the face from the chin. From here, we can check for any angling in the forehead. This angle also offers a good opportunity to see if one side of the forehead is more prominent with angling to the other side.

Head shapes comparing normal to plagiocephaly from below

What to look for

  • Forehead is angled or one side of forehead is more prominent
  • Face is sloped and appears lopsided
  • Eyes and ears are not level
  • One cheek and side of the face are fuller than the other
  • Head is abnormally wide
  • Widest part of the head is just above the ears
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FAQ

Is plagiocephaly preventable?

Simple at-home practices including supervised tummy time and repositioning techniques are known to prevent and improve abnormal head shapes up until about four months of age. Additionally, limiting the use of convenience devices, such as car seats, infant carriers and swings, is also recommended.

Will plagiocephaly go away on its own?

Our research has not shown self-correction in most cases. Remember that an external force was present to cause the deformity, therefore an external force must also be present to correct it. Once your baby is sitting up and moving about, the head will continue to get bigger, but the shape will remain the same. For children less than 4 months old, supervised tummy time and repositioning techniques can sometimes be enough to correct an abnormal head shape.

When to be concerned?

Both age and severity of the head shape are two factors that have a significant impact when treating flat spots.

Repositioning at 0-3 months of age

Since the head is very soft at a young age and grows rapidly, an uneven head shape can be common. Generally, for younger babies experts will recommend that parents use these techniques to help alleviate pressure to the head:

  • Reposition the baby often when awake, including side lying, supported sitting and tummy time, to alleviate constant pressure on the back of the head.
  • Tummy time is when the baby is placed on their stomach while awake, and supervised by a parent or guardian. This helps them develop core motor skills and the strength necessary to roll over, crawl, sit, and eventually stand. More importantly for flat spots , it decreases pressures being applied to the back of the head and strengthens neck muscles for improved head control.
  • Holding your baby is another way to help reduce pressure to the head at a young age. It also allows your baby to spend less time in restrictive devices.
What if flat spots do not go away?

Unlike other conditions, plagiocephaly can only be treated for a short window of time. The skull hardens and brain growth typically slows by age 2, at which point the shape of the head is mostly set for life.

While repositioning can sometimes correct mild flatness in babies up to 4 months old, research shows that moderate to severe plagiocephaly is unlikely to self-correct.

When is the right time to seek help?

The truth is that there is no right or wrong answer to when parent's should be concerned about flat spots.

Consulting with a healthcare professional is the best course of action to get your questions answered.

We proudly offer no cost evaluation handled by our highly trained clinicians who see hundreds of plagiocephaly patients each year.

Yes, they're 100% no-cost and require no commitment to treatment whatsoever!

How do I know if my baby needs helmet therapy?

Please note that this assessment is not meant to replace the diagnosis of a medical professional. If you’re concerned about your baby’s head shape, you can no cost evaluation at the clinic location nearest you.

Cranial remolding therapy - when is it necessary?

While these at-home assessments can be a good indicator of plagiocephaly, cases can range from mild to moderate and severe. A physician will recommend molding helmet therapy if the condition is severe enough where mild intervention will not correct the issue.

The good news is that mild cases of plagiocephaly can often resolve over time with proper repositioning techniques and supervised tummy time. These physical therapy activities help or encourage the baby to alter their head position frequently so even growth occurs.

Determining the correct course of treatment for your baby will require a proper diagnosis from a medical doctor or plagiocephaly specialist.