Expert Evaluation in NYC & the Hamptons
Noticing a flat spot or unevenness in your baby's head shape can raise a lot of questions. You may see flattening on one side, a flatter area across the back, uneven ears, or a forehead that looks more prominent on one side. These changes are often related to positional plagiocephaly or brachycephaly. When I evaluate a baby with a head-shape concern, I don't look only at the shape of the skull. I want to understand why your baby is spending more time with pressure on one area of the head and whether movement or positioning is contributing. Through Motor Skills Matter, I provide individualized, in-home pediatric physical therapy evaluations for babies with plagiocephaly, brachycephaly, torticollis, and related movement asymmetries throughout NYC and the Hamptons.
What Is Plagiocephaly?
Positional plagiocephaly describes asymmetrical flattening of a baby's head, most commonly involving one side of the back of the skull. You may notice a flat area on one side, one ear appearing farther forward than the other, unevenness when looking down at your baby’s head from above, one side of the forehead appearing more prominent, a strong preference for looking in one direction, a head tilt or difficulty turning equally toward both sides. Brachycephaly looks somewhat different. Instead of flattening primarily on one side, the back of the head may appear more broadly or symmetrically flat, making the head look wider. Some babies have characteristics of both.
Why Does a Baby Develop a Flat Head?
A baby's skull is especially moldable during early infancy as the brain and skull are growing rapidly. If pressure repeatedly occurs in the same area, the shape of the skull can begin to change. Sometimes factors that contribute to head shape begin before birth or around the time of delivery. In other babies, positioning and movement patterns during the first weeks and months play a larger role.
Prenatal and Birth-Related Risk Factors
Your baby's position and experiences before and around birth can provide useful information when I evaluate head shape. Factors may include breech or transverse positioning, multiple births, limited space or positioning in the uterus, prematurity, a difficult or prolonged delivery, forceps- or vacuum-assisted delivery, or head molding associated with birth. These factors don't mean your baby will develop plagiocephaly. I ask about pregnancy, positioning in utero, birth history, prematurity, and delivery because that information can help me understand how a particular head shape or movement preference may have developed.
Movement and Positioning After Birth
Once your baby is home, the way they move and the positions they spend time in can also influence head shape. I look for a strong preference for looking in one direction, torticollis or limited neck movement, difficulty keeping the head in midline, limited tummy time, fewer opportunities for floor play, low muscle tone, or anything else that makes changing position more difficult. Sometimes you notice the flat spot first. During the evaluation, I may find a subtle head preference, limited neck or trunk movement, or another movement pattern that helps explain why pressure keeps occurring in the same place.
Baby Equipment, “Containers” and Head Shape
Car seats, swings, bouncers, loungers, activity seats, and other baby equipment can make daily life easier, and some are necessary. I don't want you to feel that using baby equipment means you have done something wrong. What I look at is how your baby is positioned, what each product is being used for, and how much of your baby's awake time is spent with the head and body supported. A baby may move from a car seat to a stroller attachment and later to a bouncer or swing, so the total amount of supported time can add up even when no single product is being used excessively. During an evaluation, I can look at the equipment you already have and help you decide what is useful for your baby's current stage, whether positioning can be improved, and when your baby may be ready to move on from a particular product. There isn't one perfect baby product or a specific number of minutes that works for every baby. I want to help you find a practical balance between the equipment you need and opportunities for tummy time, floor play, carrying, and unrestricted movement. Sometimes the most useful developmental setup is also the simplest: a safe space on the floor and the freedom to move.
The Head Shape Is Only Part of the Story
One of the things I want to understand is why pressure keeps returning to a particular area of your baby's head. Your baby may be able to turn the head both ways when you help but consistently choose one side independently. There may be a subtle head tilt, difficulty rotating through the trunk or shifting weight equally, or limited tolerance for tummy time. This is why I don't evaluate head shape in isolation. Movement symmetry gives me important information about what may be contributing to the pattern.
Plagiocephaly and Torticollis Often Occur Together
If your baby has torticollis, they may repeatedly turn or tilt the head in the same direction. That can place more pressure on one area of the skull and contribute to positional flattening. Once that preference is established, your baby may continue returning to the same position. I therefore look at neck mobility, head position, trunk alignment, strength, tummy-time skills, and movement symmetry whenever I evaluate a baby with a head-shape concern.
Objective Head-Shape Measurements With SoftSpot
Visual observation gives me useful information, but I also value objective measurements when I am monitoring infant head shape. When appropriate, I use SoftSpot™, technology designed to obtain cranial measurements from images of an infant's head. SoftSpot provides measurements including the Cranial Index/Cephalic Index (CI) and Cranial Vault Asymmetry Index (CVAI). I can use these measurements along with my clinical examination to quantify head shape and follow changes over time. SoftSpot is one part of my evaluation. It does not replace assessment by your pediatrician or cranial specialist, and I do not use it to determine or design a cranial helmet.
What Does a Plagiocephaly Physical Therapy Evaluation Include?
I want to understand much more than the measurements of your baby's skull.
Depending on your baby's age and presentation, I may assess:
- Head shape, head tilt, and rotational preference
- Active and passive neck movement
- Muscle tightness and body tension
- Head, shoulder, and trunk alignment
- Ability to maintain the head in midline
- Tummy-time skills and weight shifting
- Rolling, reaching, and emerging transitions
- Overall motor development and movement symmetry
I also talk with you about pregnancy and birth history, prematurity when applicable, feeding and carrying positions, sleep setup, tummy time, floor play, and infant equipment. Putting these pieces together helps me understand what may be contributing to your baby's head-shape pattern.
How Can Physical Therapy Help?
Physical therapy does not directly reshape your baby's skull. My role is to address movement and positioning factors that may contribute to repeated pressure on one area of the head. Depending on what I find, I may work on neck mobility, active head turning, midline head control, tummy time, trunk rotation, weight shifting, reaching, rolling, postural control, and movement variety. I also show you practical ways to vary your baby's position during carrying, feeding, diaper changes, floor play, and other everyday routines. I don't want you to spend the day constantly repositioning your baby. I want to create more opportunities for comfortable, varied, symmetrical movement within the routines you already have.
Tummy Time and Head Shape
Supervised tummy time while your baby is awake gives them opportunities to develop strength and movement skills while also spending time without pressure on the back of the head. Simply telling you to “do more tummy time” may not solve the problem if your baby has torticollis, body tension, reflux, weakness, or a strong positional preference. I look at why tummy time is difficult and help you find positions that are more manageable, using support when appropriate and gradually progressing toward more independent floor play. I want tummy time to become a useful movement experience, not a daily battle.
Does My Baby Need a Helmet?
Not every baby with plagiocephaly needs a helmet. The decision depends on factors that include your baby's age, the degree and type of head-shape asymmetry, how the shape changes over time, associated torticollis or movement restrictions, and recommendations from medical and cranial specialists. For some babies, positioning changes and physical therapy are sufficient. Babies with more significant or persistent head-shape differences may be referred for evaluation for a cranial orthosis or helmet therapy. My role is to assess your baby's movement, address musculoskeletal and developmental factors, monitor head shape objectively when appropriate, and recommend consultation with other specialists when needed.
What About Craniosynostosis?
Positional plagiocephaly is different from craniosynostosis. Craniosynostosis occurs when one or more skull sutures fuse prematurely and requires medical evaluation. I do not replace your pediatrician or craniofacial specialist in diagnosing skull abnormalities. If your baby's head shape or clinical presentation raises concerns beyond a positional issue, I recommend appropriate medical follow-up.
Safe Sleep Still Comes First
Even if your baby has a flat spot, continue to place your baby on their back for sleep according to safe-sleep recommendations. I address positional pressure during awake, supervised time through tummy time, floor play, carrying, movement, and varied positioning. Pillows and positioning devices should not be placed in your baby's sleep space to try to correct head shape.
Why Early Evaluation Can Be Helpful
You don't need to wait for a flat spot to become severe before asking questions. During the first months, your baby's skull is growing quickly and early movement preferences may be easier to identify. An evaluation can help me determine whether your baby has a positional preference or torticollis, whether movement asymmetry is contributing, how motor development is progressing, and whether head-shape measurements should be monitored. I can also help you decide what changes to make during everyday routines and whether another specialist should be involved. Sometimes reassurance and a few targeted changes are all you need. Other babies benefit from ongoing physical therapy. The evaluation helps me determine which level of support is appropriate for your baby.
Why Choose Motor Skills Matter?
I am Dr. Tara Liddle, PT, MA, DPT, PCS, a Board-Certified Pediatric Clinical Specialist with more than 30 years of experience working with babies and children. My background includes extensive experience with newborns, premature infants, neonatal follow-up, and early motor development. I am NDT certified and have advanced training in pediatric movement and neuromuscular treatment.
I am the author of Why Motor Skills Matter: Improve Your Child's Physical Development to Enhance Learning and Self-Esteem and a contributing author of the chapter “Physical Therapist Management of Cerebral Palsy” in Contemporary and Global Perspectives in Physical Therapy: Incorporating Clinical Practice Guidelines, published by Springer Nature. My approach combines evidence-informed practice, clinical experience, and careful observation. I don't look only at whether your baby has reached a milestone. I pay close attention to how your baby moves.
Frequently Asked Questions About Baby Flat Head & Plagiocephaly
- Will my baby's flat head correct itself?
Some mild positional head-shape differences may improve as babies become more mobile and spend less time with pressure on the same area. Your baby's age, degree of flattening, and movement preferences all matter. I can evaluate those factors and help you determine whether monitoring, physical therapy, or additional assessment is appropriate.
- Is plagiocephaly caused by putting my baby on their back to sleep?
Back sleeping remains essential for safe infant sleep. Positional head-shape changes can occur when your baby repeatedly spends time with pressure on the same area, which is why I also look at movement, positioning, tummy time, and supervised awake floor play. I would not change safe sleep practices to address a flat spot.
- Can torticollis cause plagiocephaly?
Yes. If your baby consistently turns or tilts the head toward one direction, more pressure may be placed on one area of the skull. That is why I evaluate neck mobility and movement symmetry when a baby has positional head flattening.
- Can physical therapy fix a flat head?
Physical therapy isn't a direct skull-remolding treatment. I use PT to address torticollis, movement limitations, and positional preferences that may contribute to continued pressure on one area of the skull. For some babies, this is one part of managing positional plagiocephaly. Other babies may also need evaluation by their pediatrician or a cranial specialist.
- How can I tell whether my baby's head is flat?
Looking down at your baby's head from above can sometimes make asymmetry easier to see. You may notice flattening on one side, differences in ear position, or a change in forehead symmetry. When appropriate, I can also use objective cranial measurements to provide additional information about your baby's head shape.
- When should I have my baby's head shape evaluated?
If you notice a persistent flat area, increasing asymmetry, a strong preference for looking toward one side, a head tilt, limited neck movement, or difficulty with tummy time, it is reasonable to discuss it with your pediatrician and consider a pediatric physical therapy evaluation. You don't need to wait for the difference to become pronounced before having someone take a closer look.
Concerned About Your Baby's Head Shape?
If you've noticed a flat spot, uneven head shape, head tilt, or a strong preference for looking toward one side, I can evaluate what may be contributing to the pattern and help you understand what to do next. I provide expert in-home pediatric physical therapy for babies through Motor Skills Matter in NYC and the Hamptons.
Schedule an infant physical therapy and head-shape evaluation with Dr. Tara Liddle.