Deformational Plagiocephaly (Flat Head Syndrome)

At Gillette Children’s Specialty Healthcare, our Center for Craniofacial Services treats more than 1,000 children each year who have deformational plagiocephaly (also called flat head syndrome). Gillette was the nation’s first hospital to develop an orthosis—the Gillette CranioCap® orthosis—to treat the condition.

We specialize in expert diagnosis and nonsurgical treatment of deformational plagiocephaly.  Our specialists can quickly distinguish deformational plagiocephaly from more serious conditions—such as craniosynostosis—to ensure proper management.

Why Choose Gillette?

  • We offer diagnosis and treatment from the region’s top pediatric specialists in craniofacial and plastic surgery.
  • Our Gillette CranioCap® orthosis was the nation’s first deformational plagiocephaly orthosis to receive approval from the Food and Drug Administration.
  • We provide seamless integration of assistive technology services and advanced medical care to meet your needs.
  • Our early intervention treatments lead to optimal results.
  • We recognize that the choice to treat deformational plagiocephaly ultimately rests in the hands of parents or caregivers, so we provide them with the knowledge to make an informed decision.


Deformational plagiocephaly, also called flat head syndrome, is a condition in which a baby’s head has an uneven or irregular shape caused by external forces. It often occurs before birth as a result of pressure inside the uterus, but it can also happen after birth if a baby lies frequently in the same position.

Flat head syndrome is often associated with another condition, torticollis, which occurs when the muscle on the side of the neck is shortened or tightened. Simple deformational plagiocephaly can mimic more serious conditions, such as craniosynostosis.

Deformational Plagiocephaly Causes and Risk Factors

Deformational plagiocephaly can occur in the uterus or develop after birth.

Causes Before Birth

When babies drop into the mother’s pelvis well before delivery, causing the head to rest against a flat surface, they may develop deformational plagiocephaly. Unusually large babies, breech babies and multiple birth babies are at increased risk. Intrauterine pressure from a small or misshapen uterus, or insufficient amounts of amniotic fluid, also can be factors.

Causes After Birth

After birth, the condition can occur if a baby lies frequently in the same position. As the head begins to flatten, it will naturally rest on that flat area, potentially worsening the problem.

Flat head syndrome has become more common in recent decades because of the American Academy of Pediatricians’ Back to Sleep initiative, which encourages parents to place sleeping infants on their backs to prevent sudden infant death syndrome (SIDS).  (Although it’s important to place babies on their back to sleep, we recommend frequent “tummy time” during waking hours and play.)

Deformational Plagiocephaly and Prematurity

Babies born early may be at increased risk for deformational plagiocephaly because their skull bones are softer than those of full-term babies. In addition, premature babies often remain in a fixed position during an extended hospital stay, increasing the likelihood of a flat spot developing.

Deformational Plagiocephaly and Torticollis

Babies often develop plagiocephaly as a result of muscular torticollis, a condition in which a muscle on the side of the neck is short or tight. Torticollis can limit a baby’s ability to turn toward the affected shoulder, causing the infant to consistently hold the head in one position. This prolonged, one-sided positioning can flatten one side of the head.

Deformational Plagiocephaly Symptoms and Effects

Babies who have deformational plagiocephaly, or flat head syndrome, have a flat spot on the back or side of the skull. That flatness gives the skull an uneven or irregular shape. The flat spot develops on the area of the head where babies most often rest or sleep. Because the head naturally rests on the slightly flattened area, the condition can worsen if untreated.

Deformational Plagiocephaly Diagnosis

Infants are typically diagnosed with deformational plagiocephaly, or flat head syndrome, between 4 and 8 months of age. When babies develop the condition before birth, it is sometimes diagnosed earlier.

In many cases, parents notice an irregular head shape and discuss treatment options with their pediatrician. Other times, a child’s pediatrician may point out the condition during a routine check-up. In either case, babies can be referred to Gillette for assessment and treatment.

Evaluation by Gillette’s team of craniofacial experts can confirm a diagnosis of plagiocephaly and rule out craniosynostosis, a more serious craniofacial condition that requires surgical correction.

Deformational Plagiocephaly Treatments (Gillette CranioCap® Orthosis)

If an infant has mild plagiocephaly, the condition usually corrects itself. Some families require education about proper positioning and play activities for their babies. If the flat spot is significant, or fails to correct itself, infants can begin wearing a Gillette CranioCap® orthosis (a custom-made brace for the skull). 

Babies who have torticollis, a condition that sometimes accompanies plagiocephaly, may benefit from additional treatment options, including physical therapy. To date, no alternative therapies, such as chiropractic manipulation or other manual techniques, have been shown to improve deformational plagiocephaly.

Beginning Treatment

The best time for infants to begin wearing the Gillette CranioCap® orthosis is when they are 4 to 8 months old. We can, however, initiate the process in babies up to 12 months old. After that, an orthosis is less likely to change the shape of the baby’s head because most of the brain’s growth occurs during the first 13 months of life. After that, the bones of the skull fuse and harden. Because each case is unique, and several factors can influence the decision to use an orthosis, families should consult with a craniofacial expert to guide their decision.

How It Works

The Gillette CranioCap® orthosis gradually reshapes a baby’s skull, rounding the head over three to four months. Each orthosis is custom-fit to each baby’s unique head shape. Our Assistive Technology staff uses a special laser to scan a baby’s head, creating a three-dimensional model that helps to create the lightweight orthosis.

Each Gillette CranioCap® orthosis has a snug fit in some areas and is open in others. As a baby’s brain grows, the skull slowly molds into the open areas of the orthosis, rounding the head over time.

Appointments and Care

Before babies begin wearing a Gillette CranioCap® orthosis, they need an evaluation by one of our craniofacial specialists. Once treatment begins, we typically see infants every two weeks for evaluation and adjustments. (It’s important to continually monitor and adjust the Gillette CranioCap® orthosis during the remodeling process.)

We recommend that infants wear their orthosis 23 hours a day to achieve the best possible outcomes. Follow-up appointments can take place at our St. Paul, Burnsville, Maple Grove or Minnetonka clinic locations, in addition to outreach sites throughout greater Minnesota.

Medical Insurance Questions

At Gillette, the cost of an orthosis and weekly to bi-weekly management is part of a single charge. Most insurance plans usually cover the services. Some insurance companies, however, might consider the correction of deformational plagiocephaly to be cosmetic rather than a medical necessity.

We encourage you to check with your insurance carrier regarding coverage. If you have difficulty obtaining coverage for a Gillette CranioCap® orthosis or meeting obligations for co-payments, Gillette has financing options available.

Our Deformational Plagiocephaly Services

Gillette’s integrated, physician-directed approach to assessing and treating deformational plagiocephaly leads to the best possible care and outcomes. As one of the region’s leading craniofacial treatment centers, we offer experts who can guide families through the services they need—from initial diagnosis to completion of treatment.

Specialties and services most often involved in diagnosing and treating deformational plagiocephaly include:

For more information about Gillette’s comprehensive services, search Conditions and Care.

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