A very simple, flexible routine during the early years helps babies and children feel secure in their environment. But often as new parents, we’re at a loss of what that looks like. Here are six ways to foster newborn development and head shape. 

  1. From birth, alternate sleeping positions of the head. Think of a schedule such as Monday, Wednesday, Friday and position your newborn’s head to the left. Then on Tuesdays,  Thursdays and Saturdays, position to the right. On Sundays, position to the center. It doesn’t need to be this exact schedule but the idea is to give the opportunity for all areas of the back of the head to receive pressure during sleep. If you notice that your baby is constantly moving their head to one side during sleep despite the way you lay them, touch base with your pediatrician to check for any neck tightness and a potential referral to physical or occupational therapy.
  2. Begin tummy time starting at birth, when your infant has an awake period and is supervised. By 8 weeks, 20 minutes a day is the goal. It’s often more helpful to think about the number of times per day the newborn is offered tummy time like after every diaper change or after every feed, after every nap, or gently roll your baby onto her tummy—on your forearm, your lap, or the floor. By three- to four-months old, infants receiving 90 minutes of tummy time per day are shown to develop subsequent milestones more smoothly than those that do not. Tummy time is more than just spending time off of the back of their heads—Tummy time allows for your baby to strengthen their muscles in their neck, arms, and back, and coordinate their movements. It’s good for your baby to feel the weight of gravity while on their tummy.  The earlier this occurs, the easier they will be able to move their head into different positions on their own. 
  3. Switch feeding positions. During breast or bottle feedings, alternate the side they are being fed on. This prevents excess pressure always being on the same side of the head. If you believe your baby may have a flat spot, begin completing feedings so that the non-flat side is the one resting on your arm. 
  4. Minimize time spent in equipment. We recommend that babies spend less than 90 minutes in equipment per day—less is even better! Being situated into swings or bouncy seats or the Boppy pillow on their back keeps your baby in the same, semi-reclined position, leaving them with little opportunity to strengthen and stretch their muscles. 
  5. Start visual tracking activities with your baby at birth! Like tummy time, it is never too early to start tracking. We recommend using black and white cards or books for young babies since lighter colors are still difficult to see. Tracking is another opportunity for your baby to strengthen their neck muscles and develop more head control, which are essential for head shape.  It also helps the baby understand that there is a whole big world out there to look at.  The shadows created by sunlight on the floor or a plant all make for fascination for the baby.
  6. Alternate direction during diaper changes. Especially as babies get older and as their visual systems get more mature, they prefer to look towards you. For every diaper change, switch the direction of their head and feet. If you’re changing a baby’s diaper while on the floor, it’s a wonderful opportunity for the baby to be positioned in midline and look you directly in the eyes. Similar to feeding, if you are starting to notice a flat spot, position the baby on a changing table so that when they are looking at you they are getting pressure on their non-flat side. 

There are many contributors to flattening of a baby’s head. Being aware of things that can increase likelihood of developing head shape issues and incorporating the tips listed above is a great place to start!

Note:  This article is general and suitable for all infants.  If you notice your infant having a turning preference or flattening of the head shape, a physical or occupational therapy evaluation may be beneficial to thoroughly assess the underlying reasons your infant may prefer looking one direction; measure the amount of flattening, if any; and learn specific ways to support your infant at home.   Often one to two sessions are all that is needed, sometimes more. For certain situations where the head shape is not improving and is moderate to severe, cranial banding (helmet) may be helpful.  

Written by Olivia Willis, OTD Student at Carolina Kinder Development