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Back to Sleep, Tummy to Play

Positional Plagiocephaly is the medical term for head flattening which is produced by pressure from the outside on part of the skull.

The skull is made up of several 'plates' of bone which, when we are born, are soft, flexible and not tightly joined together. Constant pressure in one area can re-shape, flatten or deform the skull.

The main cause of pressure is the baby's sleeping position. The 'Back to Sleep' campaign has been highly successful in preventing cot death or Sudden Infant Death Syndrome (S.I.D.S.)

However, many parents now never place babies on their tummies to play when they are awake. This has seen an increase in the incidence of:

  • Positional Plagiocephaly
  • Positional Torticollis - restriction of neck movement
  • Developmental Delay

These conditions are made worse by the baby being left in the same position day after day. When using cots, buggies, car seats and carriers, some babies spend almost 24 hours a day on their back, with their head against a hard surface.

A baby's neck muscles are weak and the head naturally falls to one side. If it always turns to the same side, this causes the skull to flatten on one side and the neck muscles to become tight. It is then difficult for the child to turn its head or change its sleeping position.


Positioning babies from birth to improve head shape

  • Place your baby in its cot so it turns away from its preferred side, looking into the room at toys or mobiles.
  • Limit time spent in a car seat and buggies
  • Using a baby carrier on your front can be a good way of transporting your baby as well as encouraging use of neck and back muscles.
  • Always talk to, breast or bottle feed and play with your baby on its non-preferred side.
  • When feeding your baby in the crook of your arm hold it so that he/she turns towards their non-preferred side.
  • Encourage closely supervised tummy time playing on his/her front for 5-10 minutes several times a day. It may help if you lie down next to your baby or place it on your chest.
  • You may need to use a small rolled towel under your baby's chest to help at first.
  • Try placing your baby on its front over your knees or on your chest on its tummy.
Many babies object at first, but persevere and they will soon begin to enjoy it.

'Tummy Time' will strengthen your baby's neck muscles and improve its general development.

Developmental Delay

Babies who do not spend time on their tummies may:

  • Learn to sit by themselves later
  • Have poorer head control
  • Have difficulty learning to crawl
  • Be later learning to walk

We do not recommend the use of special helmets which claim to treat plagiocephaly.
For further information or help contact:
Paediatric Physiotherapy Department
3 The Green
Stratford Road
B90 4GW
Telephone: 0121 712 8130