Doctors’ Notes


Flat Heads, Tummy Time, & Torticollis

If you have an infant, you’ve heard us recommend tummy time and check the head shape of your infant. You may have seen a baby wearing a special helmet and wondered what it’s for.

Ever since the Safe Sleep Campaign (formerly known as the “Back to Sleep” Campaign) launched in 1994, the rate of SIDS (Sudden Infant Death Syndrome) has decreased by 50%. The major tenet of this campaign is putting infants on their backs to sleep. As a result of spending more time on their backs, babies can develop flattening of one or both sides of their skull. The fancy medical term for this is “positional plagiocephaly” — or, just call it flathead.

Fewer cases of SIDS is a great thing, of course! And with some knowledge and a few changes in routine, we can help prevent the head flattening that can result.

Tummy Time

Starting in the newborn period, we recommend your baby have some “tummy time.” This is time when they are not putting pressure on the back of their head. At first, a few minutes at a time done several times a day is enough. Most very young babies are not big fans of tummy time (except when they’re sleeping, which is not recommended!). They aren’t interested in looking at that pretty pattern on the play mat yet, and they don’t have the neck muscle strength to lift their head to look around. So it’s important to change their position frequently to prevent those flat spots from forming.

Tummy time is done while your baby is awake. You don’t have to put the baby on the floor; try placing your baby on you– belly to belly. You can place your baby across your lap, or on your shoulder. All of these positions “count” as tummy time, and provide the opportunity for your baby to use and grow those neck muscles. Continue intentionally providing tummy time even after your baby can hold up his head well. When she is big enough, an exersaucer or similar item (except walkers, which are not recommended for safety reasons) could be a nice way to get baby off the back of her head. Once they can get into a sitting position, they’re usually providing their own tummy time, so you don’t have to think about enforcing that routine.

Remember, when a baby can roll over independently, it’s safe for them to sleep on their tummies. Just keep the sleep environment safe — i.e.: nothing in the bassinet or crib but the baby, no bumpers, blankets, toys, etc.

Plagiocephaly (misshapen skull) can also develop before birth, and can be a result of other medical conditions and syndromes, so we will examine your baby’s head at every visit.


Some babies prefer to hold their head to one side. In the whirlwind of having a young baby, you might not even notice it unless you look at photos (a certain pediatrician mom writing this might have had that happen in her family…!).  This can be a result of a tightening of a neck muscle and is called torticollis. Because the infant keeps the head mostly turned to one side, the back of the head on that side can become flat. We recommend frequently repositioning the babies head in this case, stimulating the baby on the opposite side to encourage him to look in the other directionand lots of tummy time. Sometimes physical therapy is recommended and helpfulfor torticollis.

So, what are those helmets for? If an infant develops a very flat head, they might be referred to a specialist at Children’s Hospital for evaluation. Sometimes they’re fitted for a special helmet that is thought to help reshape the skull. However, studies are suggesting that helmets don’t actually significantly reshape the head, and have some undesirable side effects, such as less snuggle time, skin irritation, and just generally being uncomfortable. Again, physical therapy is sometimes recommended to help babies develop stronger neck muscles. Fortunately, positional skull deformities (flat heads) are almost always treatable with non-invasive methods such as physical therapy, and can be preventable.  In short, start tummy time early and keep it up.

If you have any concerns about the shape of your child’s head, just let us know. We’re always here and happy to help.

Dr. Amy Maddalena, a Kids Plus Doc since 2006, teaches the Expectant Parent Orientation class at our Pleasant Hills Office.