Is my newborn's head shape normal? Cone heads, flat spots and the 6-week check

A normal newborn head is often not round. Plenty of babies arrive with a head that looks long, pointed or a little lopsided, and a head shaped more like a cone than a ball is common straight after birth.¹ It can look alarming in the first photos. It isn't a flat spot.

That birth shape settles quickly. Pregnancy, Birth and Baby, the Australian Government-funded health service, says a baby's head returns to a more usual shape within 6 weeks of birth.² So by the 6-week check, most of what you saw in hospital should have rounded out.

A positional flat spot usually isn't there at birth. It forms in the weeks after, on the part of the head your baby rests on, in one of two ways:

• Flat on one side of the back (plagiocephaly). From above, the head looks slanted, and the ear on that side can sit further forward.
• Flat across the back (brachycephaly). From above, the head looks wide and short.

The clearest view is from directly above. Take a photo looking straight down at the crown, then repeat it every two weeks in the same spot and light, so you can see any change. Our guide to the four signs of a flat head shows exactly what to look for.

One thing to watch: birth shape should be settling by about 6 weeks. If your baby's head looked unusual from birth and hasn't improved, see your GP rather than waiting.

Flat spots form because your baby's head is growing fast while it rests in the same place. On the World Health Organization growth standards, a baby's head grows about 6 cm around in the first 3 months, more than it grows in the 9 months after that.³ That growth pushes outwards everywhere except where the head is resting. Rest on the same spot for most of the day and night, and growth there is held back and goes elsewhere instead.⁴ That's a flat spot.

Back sleeping is right for every baby, and it's also why flat spots are so common. In a Canadian study of 440 babies checked at 7 to 12 weeks, nearly half had some flattening, and most of it was mild.⁵ This isn't something you caused.

A tight neck makes a flat spot far more likely. If your baby can't turn their head evenly, they rest on the same spot every time, and turning their head only lasts until they turn it back. A tight neck muscle (torticollis) has been reported in as many as 70 to 95% of babies with positional flattening.⁶ Our guide to why babies always turn their head to one side covers the signs.

At the 6-week check, your GP looks over your baby from head to toe: weight, length and head circumference on a growth chart, plus hips, heart, eyes and how your baby moves. Head shape is on that list too.⁷

It's a short appointment with a lot to cover, so if the head is on your mind, bring it up yourself. Take your photos from above and ask:

• Is the back or one side of the head flatter than you'd expect?
• Does my baby turn their head equally both ways?
• Does their neck feel tight on one side?
• Can we have a referral to a paediatric physiotherapist?

If you're told flat spots are common and to wait and see, that's often fair for a mild one. What nobody can tell you at 6 weeks is whether yours will stay mild, and by the time you'd know, the fastest months of head growth are behind you.

If your baby favours one side, get a paediatric physio onto the neck now rather than later. The Royal Children's Hospital Melbourne notes that physiotherapy started before 3 months is associated with a better outcome for a tight neck.⁸

Start now. Flat spots usually peak around 4 months: in a New Zealand study that measured 200 babies from birth, flattening was most common at 4 months.⁹ Most babies start rolling between 4 and 6 months. At 6 weeks, you have the most time on your side.

The fourth step is the one families find hardest, because nobody can hold a head in place overnight. That's what the Perfect Noggin is for.

The Perfect Noggin is a contoured head shaping surface designed by paediatric craniofacial surgeon Dr Gary Rogers. Its recessed cup for the back of the head takes the weight off the flat spot, so your baby's head naturally grows back into that space. It works whichever way your baby turns, with no repositioning, so it doesn't fight a favourite side. Your physio looks after the neck. The Perfect Noggin takes the pressure off the flat spot.

Safety comes first in the design. It's firm and near flat, with no loose parts and nothing strapped in, so your baby is free to move their head. Once your baby starts rolling from back to tummy, use it supervised only (watching on a video monitor counts), and stop once they're rolling regularly.

Most parents see a visible difference within 6 to 8 weeks of consistent use. Results vary. Count back from rolling and the maths is simple: every week of waiting is a week less of use. For babies 1 to 3 months, the 12-week hire ($360, about $30 a week) covers the weeks that count most, with free delivery and return in Australia. Or buy new for $450 and it's yours to keep.