My Baby Has a Flat Spot and Only Looks One Way: A Plagiocephaly and Torticollis Physiotherapy Case Study
Quick answer: A flat spot on one side of a baby's head usually comes from a head-turn preference, and the two are treated together. Stretches, positioning and tummy time started in the first few months give the best chance of improvement. In this case a baby assessed at three months had a rounder head, a better head turn and on-track motor skills by eight months, without a helmet.
This case study is based on a real baby seen by a physiotherapist in our team. The location and other identifying details have been changed or removed to protect the family's privacy.
The concern: a head turn to one side and a flattening skull
First-time parents noticed at about six weeks that their baby always looked to the same side, awake and asleep. By three months the back of the head was flattening on that side. Their GP suggested physiotherapy. The parents had not tried any exercises yet because they wanted to be shown what was safe.
What the physiotherapist found at the home visit
Neck movement: full turn to the preferred side. To the other side the baby reached about three-quarters of the range with help, and less on their own, then quickly turned back.
Head tilt: a slight tilt when held upright or on the tummy.
Neck muscles: no lump in the muscle on either side.
Head shape: flattening at the back on the preferred side, the ear on that side sitting slightly forward, and mild forehead and cheek asymmetry. On the scale physiotherapists use, this sat at the moderate to severe end.
Development and feeding: both going well.
The tight neck is called torticollis. The flattening is positional plagiocephaly. The neck limits where the baby looks, and the constant pressure on one spot shapes the soft skull.
The physiotherapy approach
Gentle neck stretches taught to the parents and done several times a day.
Positioning so the interesting things, such as faces, toys and the room, were on the non-preferred side during play, feeding and nappy changes.
Tummy time and upright play in awake windows to take pressure off the back of the head and strengthen the neck.
Safe sleep unchanged. Babies still sleep on their backs. Repositioning happens when they are awake.
Hands-on coaching. The parent was nervous about handling a small baby firmly, which is common. Visits were booked every two weeks at first to build confidence.
The physiotherapist also explained that a helmet referral would be considered if the head shape did not respond.
Progress at eight months
The flattening at the back had improved noticeably, and the face looked more even.
The baby turned to the non-preferred side more often and held it for longer, though the old preference had not fully gone.
The head tilt was almost impossible to see.
Motor skills were within the expected range for age: rolling both ways, sitting independently, pushing up on straight arms, rocking on hands and knees and starting to creep forward.
Progress came even though a busy few months and a bout of illness meant the family could not do the stretches every day. Conservative management continued, alongside routine specialist follow-up.
What parents can learn from this case
A flat spot and a head-turn preference are usually one problem with two signs.
Starting before four months matters, because the skull is softest and babies are not yet rolling away from stretches.
Head shape changes slowly. Measurements can stay in the same category for months while the head is visibly improving.
You do not need to do the program perfectly for it to help.
When to seek an assessment
See a paediatric physiotherapist if your baby always looks one way, has a flat spot that is getting worse, resists turning to one side, or feeds well on one side only. See your GP promptly if you feel a lump in the neck, the soft spot seems closed early, or the head shape is unusual from birth.
Is this covered by the NDIS?
Plagiocephaly and torticollis on their own are not usually NDIS conditions. Most families see us privately, and no referral is needed. If your baby also has a diagnosed disability or a developmental delay, physiotherapy may be part of their NDIS early childhood supports. See our NDIS physiotherapy page.
Frequently asked questions
Will my baby's flat head fix itself?
Mild flattening often improves once a baby rolls and sits. A strong head-turn preference needs stretches and positioning, or the flattening can continue.
Does my baby need a helmet for a flat head?
Most babies do not. A helmet is considered for moderate to severe flattening that has not improved with physiotherapy, usually from around five to six months.
What age is best to start physio for torticollis?
As early as possible, ideally in the first three months. Older babies still improve, but it usually takes longer.
Can a flat head affect my baby's brain?
Positional plagiocephaly changes the shape of the skull and does not harm brain development.
Home-visit baby physiotherapy in the Inner West
Sydney Child Physio is a mobile paediatric physiotherapy service. We see babies at home in Marrickville, Newtown, Dulwich Hill and across the Inner West, so you do not need to travel with a newborn. Call 0491 042 992 or contact us.
Related reading
Physiotherapy to treat Plagiocephaly