The Flat on the Back of the Head in Infancy

The Flat on the Back of the Head in Infancy- It's Safe

In 1992, the American Academy of Pediatrics made it official- all infants should sleep on their backs.
This major change has had a tremendous impact on the lives of all infants and families.

The risk of the outrageous tragedy of SIDS has indeed dropped in half in the US.

But sleeping on your back as a newborn does tend to flatten the back of your head.  Well worth the dramatic reduction in SIDS, but still can be an issue.

The flattening is very common and has a typical look to it.  It is always the back of the head that flattens, sometimes one side or the other, sometimes in the middle.  Sometimes the flattening is very mild, sometimes more pronounced.

The most important thing to keep in mind is that no matter how much flattening occurs, the brain is safe.

Whether the flattening is mild or pronounced, one one side or the other, in the middle, it never has any impact on your child's brain.  It does not slow down brain growth, it has no impact on how your child's development will unfold or progress, and it has no impact on how your child's brain will work over time- no impact on intellegence, coordination, or personality.

The reason is that the reshaping of the bones of the skull, even if very pronounced, simply does not move the brain enough, or cause enough pressure to be applied to the brain, for the brain to notice or be impacted.

The other good news is that once your infant starts sitting, the flattening typically stops getting worse.  So by 5-8 months of age, flattening hits a peak.  At that age, the head still has lots of growing to do, so from that age on, the head growth restores normal roundness and erases much of the flattening.

Occasionally the flattening is so severe that even subsequent growing of the head after age 6-9 months will leave what is seen as an unacceptable amount of shape change.

Again, the only issue that is relevant is appearance, the flattening from lying on your back cannot cause actual harm or dysfunction.

If the flattening is developing to a degree that raises concern for later appearance, there are options.

One option that is not acceptable is to place your infant on his or her stomach to sleep.  That could spare some flattening but puts infants at risk for SIDS, a bad idea.

But one approach that could help would be to see a pediatric plastic surgeon who is able to create a computer generated helmet that fits to the infant's head to reshape the head as it grows to be more round.

This is an intervention that is harmless and painful, but still a major effort involving fitting for a helmet, your infant wearing a helmet, and repeated adjustments.

Given that most flattening is mild, and that it usually resolves well enough to yield a very nice looking head, interventions like the helmet are only rarely a good idea.


  • Being put on your back to sleep is a very powerful way to cut the risk of SIDS dramatically, and it has.
  • Being on your back during infancy does cause flattening of the back of the head.
  • This flattening has no impact on the brain, its growth, its development, or its function
  • Flattening typically reverses once the infant can sit, as the head grows more round subsequently.
  • Rarely the flattening can be severe enough to justify creation of a helmet that will adjust head growth for some months.
Dr. Arthur Lavin

*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

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