Are Flat Head Pillows Safe for Babies?

Plagiocephaly, also known as flat head syndrome, is a problem that affects many new babies due to them sleeping on their back with their head in the same position for long periods.

A lot of parents search for ways to prevent Plagiocephaly, and one of the most common, easiest, and most readily available options is a new pillow that is said to prevent flat head in babies. However, as parents, we need to know if this is the safest option for our babies.

A flat head pillow is not recommended as it could put your child at risk for other complications such as SIDS (Sudden Infant Death Syndrome), overheating, or even suffocation. Babies should not use pillows as it puts them at risk for other, more serious complications.

Safe sleep guidelines should be followed very strictly, and parents should take it very seriously to ensure their baby stays safe and healthy. All pillows and any other items that are marked as safe for babies should be avoided or used only under strict supervision by the parent.

Why is it not safe to use a pillow for my baby?

Using a flat head pillow for your baby while they are awake, alert, and within your view may be an option to help prevent flat head. However, using any pillow for your baby while they sleep poses many risks for your little one.

Using a pillow for your baby while they sleep could put them at higher risk of complications such as SIDS (Sudden Infant Death Syndrome), overheating, or even suffocation.

A pillow could move or shift while your baby sleeps and end up covering their face, which could cut off their airway and cause suffocation. The baby’s head may also fall forward, which will cause their chin to be pushed down onto their chest, causing their airway to become blocked and restrict their airflow, which can also cause suffocation.

Using a pillow for older babies in a crib or cot could increase the risk of accidents if the baby tries to use the pillow to climb out of the cot or crib. And they may end up falling out or slipping and falling into the crib and may cause head injuries or even broken bones.

Keeping my baby safe during sleep?

Remember to follow safe sleep guidelines to keep your babies safe and sound while they sleep. To keep your baby safe while they sleep and ensure they are not at risk of SIDS, suffocation, or any other sleep-related accidents, keep unsafe items out of your baby’s sleep environment.

The following items are considered as unsafe items to keep in a baby’s sleep environment and parents should avoid having them where their baby sleeps:

  • Flat head pillows
  • Baby pillows
  • Wedges or wedge pillows
  • Blankets
  • Duvets
  • Quilts
  • Loose bedding
  • Crib bumpers (especially bumpers with ties)
  • Bedding rolls
  • Toys

Having any of these items in your baby’s crib, cot, or sleep environment can increase your baby’s risk of sleep complications such as SIDS or suffocation.

When is it safe for my baby to use a pillow?

It is recommended not to start using a pillow for babies until they are over the age of 2 years old, and they are not sleeping in a cot or crib anymore. By this age, they are more capable of turning their heads freely and safely to prevent suffocation, and they are at much lower risk of SIDS.

Babies should always sleep on a flat, firm surface until at least age 1. There should be nothing but a fitted sheet in their cot or crib. There are many fitted alternatives to a blanket or pillow such as wearable blankets or cribs that list on 1 side instead of using a pillow.

What is Plagiocephaly or Flat head syndrome?

Plagiocephaly, also known as flat head syndrome, is a medical condition that happens when a baby lays on their back, and their head does not change position for long periods. This eventually causes a flat spot to develop on the back or side of the head where the head is in contact with a flat surface for long periods.

What causes Plagiocephaly/Flat Head Syndrome?

Flat head syndrome occurs because the skull bones in a baby’s head do not harden and fuse together after birth, and only happens several months later. Because the bones are soft and pliable, it causes the head to be able to change shape easily. So, sleeping in the same position regularly is the most common cause of flat head syndrome.

This can also happen when a baby is placed in a baby carrier, baby car seat, stroller, bouncer, baby chair, baby swing, or in other places where the baby’s head is in the same position for a long period with the head on a flat surface.

Premature babies are at higher risk of getting a flat head because the skull of a premature baby is sofer and more pliable than the skull of a baby born at full term. Premature babies also tend to spend a long time on their back in the NICU (Neonatal Intensive Care Unit)  in incubators, where they are not carried, held, picked up, or moved due to their medical and health needs.

Babies have difficulty moving the muscles in their necks due to them being weak, so they need a lot of energy to help them move their necks. Therefore, when a baby ends up getting a flat spot, they tend to continue laying in that same position instead of moving.

This could cause the neck muscles to stiffen and make it even harder for them to move their heads and could also make the flat spot on the head worse over time. When the neck becomes stiff and difficult to move, this is called infant torticollis.

How to prevent Plagiocephaly/Flat Head Syndrome

There are ways to help prevent Plagiocephaly before it starts or before it gets too bad, and your baby is unable to move their neck freely.

  • Tummy time: Letting your baby play on their tummy several times a day for short periods will help to prevent flat head and is also great for helping your baby to develop strong neck muscles, as well as strengthening their back and hip muscles. You can start by letting your baby have short sessions that last 3 to 5 minutes. Do this several times a day, starting as soon as you are home from the hospital. Work your way up to your baby having a total of 60 minutes a day tummy time or more if they are not too fussy.
  • Repositioning: Making small position changes can help prevent flat head syndrome. Move items of interest from one side to another to encourage your baby to turn their head to look for the items (this will help them to strengthen their neck muscles, making it easier for them to change head positions independently)
    • Change sleeping positions changing your baby’s head position every 30 mins during naps and alternating positions daily during night time sleeps, or changing head position everytime your baby wakes for a feed during the night can help to prevent flat head and help strengthen their neck muscles. Baby should always be put down to sleep on their back, but the head position can be changed regularly.
    • Napping positions: During daily naps, if a baby is constantly supervised throughout their nap, put your baby to sleep on their tummy. This can also help prevent head flattening. (NOTE: tummy time naps should be under strict, constant supervision
    • Change Feeding positions: while feeding your baby (whether breast or bottle), change the side and position you feed your baby (Ex: switching from left arm to right arm). This will help put less pressure on one point of the head.
  • Carrying your baby: carrying your baby in your arms for short periods throughout the day will also help put less pressure on your baby’s skull, which will help prevent the head flattening.
  • Regular or daily baby massage: infant torticollis, which is the stiffening of a baby’s neck due to lack of movement, can be relaxed with regular baby massage done by a pediatric massage therapist or a parent who has had training in baby massage.

Searching for a good baby massage class in your area can be extremely beneficial as a baby massage can also help with a variety of other areas of baby development).

Once your baby learns to sit on their own, the flat spot will stop worsening and start getting better. Over the next few months and years, the flattening will start to become less visible and less noticeable as the skull grows and starts to harden. This will happen even in very severe cases.

Plagiocephaly does not affect a baby’s development or brain growth in general. However, infant torticollis can affect early development, so physical therapy and special neck exercises can help prevent and treat any delays.


Flat head syndrome is usually not a serious problem and will, in most cases, improve naturally with growth over time. Following preventative measures will help with prevention and healing if flat head has already started.

Plagiocephaly is a common occurrence in babies and is temporary and treatable without the use of a flat head pillow that could cause more harm than good.

Article checked by:
Dr Binu George – Consultant General Pediatric
(MBBS, FRCPCH, Dual CCST (UK), Paediatric Neurodisability)
Head Of Department, Child Development Department at
NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates

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