ChestI am so excited to announce a partnership with Baby Begin!  Baby Begin is dedicated to keeping your baby's head round and symmetric. They can be found at babybegin.net. This post was written by occupational therapist Jennifer Todd Barnard and her bio can be found below.  Enjoy!

Newborns do not come with instructions. As a new parent, you have probably realized this and have tediously searched out hundreds of resources to make this new chapter in your life as easy as possible. Fortunately, the options are endless and you will, at some point, find the answers to each and every question you have.

You may not even know about flat head syndrome – many new parents don’t until it is too late. But what you probably REALLY don’t know is that 46% of infants will have some degree of flattening on the skull by the time they are four months of age! That is a LOT of babies. It happens really quickly, but guess what? This condition is preventable, especially when you have the information before you truly need it!

Lucky for you, Dr. Jaime Friedman and Baby Begin have teamed up to give you the down and dirty about positional plagiocephaly (flat head syndrome) and how to prevent it. Follow these easy tips from the get-go and you can ensure your baby has a round noggin forever. No helmet, thank you very much. ☺

(Plagiocephaly, or flat head, can occur for other reasons besides positioning so please see your pediatrician with any questions)

Repositioning- ROTATE THAT BABY!

Babies should always be put to sleep on their back on a flat surface like a bassinet, pack n play or crib, without a bumper or extra bedding.  Try, though, to turn the baby’s head a different direction at each sleep time. Rotate her in the crib so she faces different directions. Alternate which side you are feeding her, changing her diaper and carrying her.

The key here is to watch if your baby always turns her head in the same direction. If you see a preference, talk to your pediatrician right away. You might need a physical or occupational therapist to evaluate for neck tightness (torticollis) that is probably causing her to only look in one direction. Early treatment of this is a critical part of preventing a flat head and can be very effective when started right away.

Tummy Time – IT ROCKS!

Supervised tummy time should be started as soon as you get home from the hospital. On your chest, lap or the floor are all good options. The baby may not like it at first, but will adjust quickly if you do it in small increments and start early. Try to incorporate supervised tummy time into your daily schedule, just like you do feedings and diaper changes. Remember, the more time a baby is off the head, the easier it is to grow in a normal shape. The first two to three months are the most critical time for your baby’s head shape, so start now – don’t wait!

Incline Surfaces/Containers – USE AT YOUR OWN RISK!

These can be your best friend but also your biggest enemy, so use them with caution. An “incline surface” includes a car seat/carrier, nap nanny, swing, Rock n Play and bouncy seat. Combined, these should not make up more than three (yes- just three) hours of your baby’s day. Don’t forget to count all shopping trips, meals out, naps, walks, errands, siblings’ activities, etc. It adds up quickly, so watch it closely. (If you have multiples, this gets a little more complicated – so do your best.) Remember – your baby should always sleep on a flat surface on their back.

For some babies, an incline surface is recommended after feedings for reflux (severe spitting up). If this is the case, you might need to collaborate with a therapist to work in accordance with these important precautions while at the same time keeping your baby’s head round.


Keep a close eye on the shape of your baby’s head from the moment you get home from the hospital. The best way to look at it is from a “bird’s eye view,” or looking down on it from the top. This is how you can tell if there is any flattening or asymmetry. Typically, the flattening will begin in the back, so this is a good place to keep an eye on. If you see any flattening, immediately let your pediatrician know so you can address it right away. A “wait and see” approach does not work in this situation. While many pediatricians can give positioning or stretching advice for you to use at home, it can also be helpful to see a therapist so ask for a therapy referral so you can correct the issue before it becomes a much bigger problem. Remember, the first four months is your window of opportunity.


BB-2601Jennifer Todd Barnard


Jennifer Todd Barnard founded Baby Begin, because she’s passionate about educating families on keeping their babies’ heads round. She’s a pediatric occupational therapist who has been treating plagiocephaly (flat head syndrome) and torticollis, (tight neck), exclusively, since 2000. She is hoping to make a breakthrough and eventually eradicate plagiocephaly as we know it. To that end, she is actively involved in educating physicians, families and other therapists in the community and around the country.

She has developed the “1st Step Plagio Plan” which promotes awareness, effectively treats torticollis and corrects skull asymmetries through infant physical/occupational therapy, without the use of a helmet. To date, thousands of infants, pediatricians and therapists have benefited from these strategies and if Jennifer Todd Barnard has anything to say about it, there will be a lot more! She is the mommy to one very special little girl Anabelle, step mommy to two very smart college girls Lauren/Aubrey and wife to a really cute tennis pro Tim. Life is busy and that’s how she likes it!

Author: DrJaimeFriedman

I am a mom and pediatrician here to dispense timely and accurate information about the health and well being of children.
Please see my first blog post, which explains how I got started.

Remember, this is not a substitute for medical advice and is not a private platform.


2 thoughts on “FLAT HEAD SYNDROME (Positional Plagiocephaly) – WHAT YOU NEED TO KNOW”

  1. Dear Dr. Friedman:
    I enjoyed this article about plagiocephaly. My family has experienced it first-hand. Thanks for providing such a good educational resource.
    Brian Smart, MD
    An Allergist/Immunologist’s Guide to Living Well

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