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Infant Flat Spots


Flat spots, medically referred to as Plagiocephaly and Brachycephaly, is the term used for flattening of an infants skull.

  • Plagiocephaly is the flattening of 1 side of an infants posterior (back side) skull

  • Brachycephaly is flattening of both sides of an infants posterior skull

🚨Flat spots are NOT just cosmetic and will likely create issues elsewhere in the body! Here are some ways flat spots can affect infant development:


👉🏼 Creates a preference for one sided head turning leading to more flatness and neglect of using 1 side of the body

👉🏼 Promotes muscle imbalances leading to compensations

👉🏼 Tightness of the neck, trunk, shoulder or hip causing difficulty with movement and avoidance of appropriate posture due to poor tolerance of feeling muscle stretch

👉🏼 Asymmetry with motor skills such as only rolling to 1 side or reaching with 1 hand



Don’t take the “wait and see approach” as head shape is unable to correct after 12-18 months of age due to the fusion of infants skulls as they grow! Positioning is most effective <4 months old as infants don’t have complete head control and aren’t rolling yet. If a flat spot is not treated before this, a helmet will most likely be recommended for infants 4-6 months or older.


How Physical Therapy can help:


Positioning with play

  • Encouraging caregivers to have baby play in side lying to help reshape the head, but this will be dependent on what side of the head is flat

  • Tummy time to give pressure relief off of the flat spot and strengthen the muscles attached to the skull bones to help reshape the skull

  • Supine play placing toys on opposite side of the flat spot to give pressure on the bossing side

Stretching & strengthening

  • Stretching the neck, shoulders or trunk if there is tightness to make achieving midline easier for infants

  • Strengthening the neck (front, sides and back) as well as the core

  • Working on achieving and maintaining head in midline to bring midline awareness

  • Tracking a toy to both sides from midline to ensure neither side is being neglected

Providing encouragement to caregivers with individualized HEP:

  • Educating patents on all aspects of the flat spot (tightness? asymmetries? compensations?)

  • Creating an individualized home exercise program (HEP) for parents to perform daily with their infant. Our PT will review and demonstrate all exercises/activities in session to ensure caregivers feel confident carrying over daily until the next session

  • Each session will start with a review of the HEP to identify the progress since the previous session to give parents reassurance that they are making a difference!

  • Updating the HEP as the patient progresses

Identifying the need for an outside referral:

  • Understanding the cause of the flat spot to rule out the need for additional referrals to include: visual impairment, broken clavicle, palpable mass in a muscle in the neck, craniosynostosis, etc.

  • Identifying the severity of the flat spot with the age of the patient to determine if a referral for a helmet is necessary


Our physical therapist can help progress patients with flat spots to ensure proper development and head shape! Reach out to our physical therapist Jessie Lanford today for a screen or any concerns!


706-840-0369




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