Newborn head shape: cone heads, soft spots, flat head syndrome and what is normal

A newborn's head shape is often uneven at first, and most of the time that's normal. HealthHub explains that your baby's head "may look like a cone or elongated" after a vaginal birth, because the skull bones overlap as they squeeze through the birth canal, and that it "will return to a normal shape as he grows". A flat patch that appears later, from lying the same way for weeks, is called flat head syndrome. KKH says it affects about three in 10 babies by four months, that it is highly preventable and treatable, and that mild cases usually improve once your baby rolls and sits. Changing your baby's head position at every sleep, plenty of tummy time while awake and less time in car seats and rockers prevent most of it. If the flat spot is still there or getting worse at around four months, or your baby always turns to one side, ask your doctor: helmet therapy works best between four and eight months.

Newborn head shapes at a glance

Moulding and soft spots in the first weeks

A newborn's skull is made of thin, flexible plates that aren't joined yet, so it can change shape to fit through the birth canal. SingHealth says the bones of a newborn's head "are thin and flexible so the head is soft and may change shape easily". It adds that an uneven shape can start with the baby's position in the womb or happen during the birth itself.

The soft spots, called fontanelles, are gaps where the bones haven't grown together. HealthHub says the front one is usually easy to feel and diamond shaped, may bulge slightly when your baby cries or strains, and usually closes within 12 to 18 months.

HealthHub also reminds parents that a baby has little control over the head until the neck muscles strengthen at about six months, so support the head and neck whenever you pick up or lay down your baby.

Flat head syndrome: why it happens and how common it is

Babies should always sleep on their backs, because sleeping on the tummy raises the risk of sudden infant death syndrome (SIDS), SingHealth says. The trade-off is that a soft skull resting the same way for many hours can flatten. KKH explains that flat head syndrome "is most often caused by babies spending prolonged periods on their backs with the head in the same position", and that torticollis, tight neck muscles that make it hard for a baby to turn the head, can make it worse.

Numbers from KKH, which opened Singapore's first dedicated clinic for it, the PlagioCentre, in June 2025:

• Worldwide, up to 22% of infants have some flattening by six weeks, and nearly 30% by four months.
• KKH's diagnosed cases rose 36% in two years, from over 800 in 2022 to more than 1,000 in 2024, which KKH says reflects greater awareness of the value of early detection.
• Mild cases often resolve naturally as babies start to turn over and sit up.

SingHealth adds that positional plagiocephaly "does not affect the development of a baby's brain", but if not treated it can make the face and head grow unevenly. KKH notes that untreated moderate to severe cases can, in extreme cases, affect jaw development and vision, and make protective headgear hard to wear later.

How to prevent a flat head at home

These come from KKH's leaflet for parents and HealthXchange's flat head advice:

1. Turn your baby's head at each sleep: to the left, to the right, then straight. KKH says you can turn it once your baby is sound asleep. Always keep your baby on the back to sleep.
2. Swap ends of the cot each night, so your baby has to look the other way towards the door or window.
3. Move toys and mobiles every few days, and talk to, feed and carry your baby from both sides.
4. Put your baby on the side or tummy while awake at least three to five times a day, KKH suggests.
5. Do short, frequent tummy time: one to two minutes before every feed to start, building up as your baby gets stronger. Lying your baby on your chest counts.
6. Limit time in the stroller, car seat, swing or rocker, and avoid naps in them, KKH advises. Take your baby out of the car seat when you're not travelling.
7. Skip flat head pillows. HealthXchange says doctors discourage them because they aren't proven to work, and soft pillows go against safe sleep advice.

Our guide to newborn toys and games by age has tummy time ideas, and baby milestones month by month shows when rolling and sitting usually come.

When to see a doctor, and what treatment involves

SingHealth lists a head shape that is still uneven more than six weeks after birth, or a flattened spot at the back or side, as signs of plagiocephaly. KKH asks parents to see a doctor if their baby always turns or tilts the head to one side and has trouble looking the other way, or if they've tried the tips above and are still concerned. Your baby's check-ups at the polyclinic are a good time to raise it.

SingHealth says that when treatment is needed, it's best to see a specialist between four and eight months, because most correction happens before 12 months. At KKH's PlagioCentre, a team of neonatologists, physiotherapists and orthotists assesses each baby. Babies who need a helmet get a custom 3D-printed one from a scan of their head. KKH's leaflet says the helmet is worn 23 hours a day, presses lightly on the bulging areas and leaves room for the flat side to grow, and most babies show visible improvement within two to three months. The first visit, with measurements and a 3D scan, takes about an hour and includes advice on the cost; fitting follows one to two weeks later, then monthly reviews.

To get there, KKH says to speak to your child's paediatrician at KKH or visit any polyclinic, which can refer you. Our guide to choosing a paediatrician and the paediatrician map help if you don't have one yet.

Frequently asked questions

When does a newborn's cone head go away?

HealthHub says the elongated or cone shape from a vaginal birth happens because the skull bones overlap in the birth canal, and that the head returns to a normal shape as your baby grows.

Is a flat spot on my baby's head normal?

It's common. KKH says flat head syndrome affects three in 10 infants by four months of age. Mild cases often improve as babies roll and sit. Ask your doctor if it isn't improving by about four months.

Does flat head syndrome affect my baby's brain?

No. SingHealth says positional plagiocephaly does not affect brain development. Untreated moderate to severe cases can affect how the face and head grow, which is why early checks matter.

When is helmet therapy needed?

For moderate to severe flat head. KKH offers helmets to babies under eight months, and its leaflet calls four to eight months the best time to start. Helmets are worn 23 hours a day, usually for a few months.

Do flat head pillows work?

HealthXchange says doctors discourage them because they aren't proven to work, and pillows in the cot go against safe sleep advice. Repositioning and tummy time are the recommended steps.