Why the “Wait and See” Approach May Harm Your Baby’s Head Shape – And What to Do Instead
As a parent, you want the best for your baby, especially when it comes to their health and development. Oftentimes, when parents raise concerns about their baby’s head shape—whether it’s flattening or asymmetry—many are told to adopt a “wait and see” approach. While this advice is not given in ill will, waiting too long (even a month!) can have lasting consequences on your baby’s head shape and development.
As a pediatric physical therapist, I believe early intervention is key to ensuring your munchkin develops a healthy head shape. The “wait and see” approach is often recommended when pediatricians notice slight flattening or asymmetry in a baby’s head, known as brachycephaly or plagiocephaly. Pediatricians may suggest monitoring the condition for a few months before pursuing any treatment, assuming that your baby’s head will round out naturally over time as they grow and move more. However oftentimes this head shape does not resolve independently from intervention.
The root cause for head shape abnormalities is compromised gross motor movement, which is why early intervention by a pediatric physical therapist is important. Babies who have visible flattening of the skull need more targeted interventions to correct the issue, specifically the root cause. Waiting too long before seeking help can make it worse, and will likely lead to needing more care with a physical therapist in the long run.
A baby’s skull is soft and pliable during the first year of life, which is what makes early intervention crucial. The bones of the skull are connected by soft fibrous bands called sutures, allowing the skull to grow as the brain rapidly develops. However, as babies get older, the skull bones begin to fuse, and the sutures start to close, typically around 12-14 months. Once the sutures are closed, the head shape cannot be altered.
Here’s why waiting can be problematic:
Limited Time for Change: The earlier you address head shape issues, the faster we see results. This leads to less appointments/sessions and interventions. After the sutures begin to close, there’s little to no opportunity to reshape the skull, and any existing flattening or asymmetry becomes more permanent.
Potential Impact on Development: If left untreated, a misshapen head can potentially affect more than just appearance. Flattening of the head is typically caused by tightness in the muscles and fascia of the neck and pelvis (torticollis) which may impact your baby’s motor development, such as rolling, crawling, and sitting.
Decreased Treatment Effectiveness: If treatment is delayed until later in infancy, more aggressive interventions like helmet therapy may be required. Early intervention with conservative methods, such as physical therapy and positioning changes, can often prevent the need for more invasive treatments.
If you notice any flattening or asymmetry in your munchkin’s head shape, here is what I recommend:
Pediatric physical therapists are specially trained to assess and treat head shape abnormalities, as well as other developmental issues in infants. A pediatric PT can identify the underlying causes of the flattening, such as tight neck muscles, jaw and pelvic mobility. The physical therapist will provide tailored exercises and positioning strategies to promote proper head shape development. It’s never too early to see a pediatric physical therapist! I often have parents bring their munchkin to me before they turn 1 month old!
Early intervention can help prevent the need for helmet therapy and improve your baby’s overall motor development. The sooner you get an assessment, the better the outcome.
Tummy time is one of several positioning recommendations that can help to prevent and correct head shape issues. When your baby spends time on their tummy, it relieves pressure from the back of their head, allowing for more balanced skull development. Tummy time also strengthens neck, shoulder, and core muscles, which helps with rolling, crawling, and other motor skills.
Start tummy time as soon as possible, even if it’s just for a few minutes a day. Gradually increase the duration as your baby becomes more comfortable.
If your baby tends to favor one side while sleeping or resting, it’s important to alternate their head position to reduce pressure on the flattened area. This is best done under the recommendations by a physical therapist so they can help to make it easy and comfortable for your munchkin to look to their non-preferred side. Most pediatricians recommend to turn the baby’s head to the non-preferred side, however this does not treat the asymmetry from a whole-body perspective. This advice leaves out other crucial areas of the body that contribute to the side preference.
In the meantime while you’re waiting to get in with a physical therapist, you can:
Alternate the direction your baby faces in the crib each night.
Use toys or mirrors to encourage your baby to turn their head to both sides while awake.
Limit time in car seats, swings, and bouncers, as these can put prolonged pressure on the back of the head.
Regularly check your baby’s head shape and discuss any concerns with a pediatric physical therapist. Even if your baby seems to have mild flattening, staying proactive with positioning, tummy time, and PT guidance can prevent the problem from worsening.
If you have concerns about your baby’s head shape, don’t wait—reach out to a pediatric physical therapist to get the guidance and support you need. You DO NOT need a referral from your pediatrician to see a physical therapist. So if you have concerns and you’re advised to “wait and see”, reach out to a pediatric physical therapist directly. Your munchkin’s health and development are worth it!
