# Before 'Back to Sleep': Why Flat-Headed Babies Aren't Just a Modern Problem *The earliest known cases of flat head syndrome in Italy suggest ancient parents faced the same problem as modern ones.* By Sandee Oster · Published 28 September 2026 Source: https://archaeologyteahouse.com/stories/before-back-to-sleep-why-flat-headed-babies-aren-t-just-a-modern-problem Primary source: [Before “Back to Sleep”: Deformational plagiocephaly and pediatric insights from Iron Age Italy](https://doi.org/10.1016/j.ijpp.2026.07.001) Subjects: [Iron Age](https://www.wikidata.org/entity/Q11764), [plagiocephaly](https://www.wikidata.org/entity/Q2546232) --- ![Two Iron Age skulls with flat head syndrome](https://archaeologyteahouse.com/media/01a0d971-47cb-7811-ac8a-dd72833ae5e5/1600.webp) *Individuals CR129 and BR81 with parts of their skulls flattened. Credit: Beck De Lotto et al. 2026* If you were a 90s baby or perhaps a 90s parent, you may have heard of the 'Back to Sleep' campaign. Okay, to be fair, if you were a 90s baby (like me), you are unlikely to remember it, but your parents may have heard of it. The aim of the campaign was simple: teach parents and caregivers to place babies on their backs to sleep to reduce the risk of sudden infant death syndrome (SIDS), also called cot death. Fair enough; it seems like a legit reason. The problem is that infants' heads are very soft, flexible, and malleable, and keeping their heads in the same position for long periods can cause the back of their skulls to flatten. This condition is known as plagiocephaly, or 'flat head syndrome'. Modern doctors have paid growing attention to flat head syndrome, with reported prevalence ranging from 16 to 47%. But babies are not a modern phenomenon; they have, of course, always existed, which raises the question: Is flat head syndrome a modern phenomenon, perhaps tied to the 90s Back to Sleep campaign or some other modern forms of infant care, or is it something far more ancient, something that has existed throughout human history? The answer can help parents and doctors understand what, if anything, can be improved with modern child care, and how parents cared for their children in the past.  Studying ancient skeletons could provide these answers, and that is exactly what archaeologists Michael Allen Beck De Lotto and his colleagues set out to do when they noticed the curiously flat heads of Iron Age skeletons in Italy. ### Old Flat Heads ![Iron age scull with flat head syndrom and some cracks](https://archaeologyteahouse.com/media/01a0d975-c487-7d1f-8855-2c674e47bfc7/1600.webp) *Top and bottom views of CR53's skull, showing its lopsided shape and the ear on the flattened side pushed further forward.* Plagiocephaly comes in two forms: the first is caused by the rare premature fusion of the skull sutures, called synostotic plagiocephaly; the second, and far more common, is called deformational plagiocephaly (DP), caused by external pressure. Roughly 38–47% of infants aged 7–12 weeks have DP, though mild cases usually sort themselves out; more extreme cases can cause a persistent flat head into adulthood. Some rare archaeological cases are known, such as 93 cases out of 745 skulls identified in a Czech ossuary in 2006, while a few more cases have since surfaced in Armenia, Switzerland and Pakistan, and one has even been proposed for a *Homo floresiensis* skull dated to between 60,000 and 100,000 years ago, suggesting the condition is not just old, but may even predate our own species. But these lopsided skulls can't all be explained by DP; many things could have caused them, from soil pressure and moisture squashing and reshaping the skull after burial to deliberate skull shaping with bandages and planks, or even synostotic plagiocephaly. This leaves archaeologists studying such skulls with the task of systematically examining each plausible explanation before they can conclusively (or at least relatively confidently) say the flat heads they are seeing in ancient skulls are in fact cases of DP. Of course, they also have to contend with the fact that skulls often break apart and can't be fit back together neatly, making it even harder to determine what they are looking at. But this did not stop Beck De Lotto, whose interest in skulls with flat heads began a few years ago during a commercial excavation. At the time, he couldn't explore the possibilities further, but he got another chance while studying skulls recovered from two Iron Age cemeteries in Italy. ### Flatter Than the Rest ![The skeleton of BR10, buried curled on its right side with its legs pulled up as if sleeping](https://archaeologyteahouse.com/media/01a0d97a-7bfb-7222-9b43-02703ef26363/1600.webp) *The skeleton of BR10, buried curled on its right side at the Brecce cemetery.  Credit: Beck De Lotto et al. 2026* The skulls came from two cemeteries located in Matelica (no, not the band, that has two Ls), a town in the Marche region of central Italy. Excavated since the 1990s, the area contains remains spanning the Iron Age into the Roman Period. Its two oldest cemeteries, Crocifisso and Brecce, date to around 850–700 BCE and contain the remains of people of the Picene culture, an Iron Age people local to the region. The dead were buried curled up on their right sides as if sleeping. By the early 2000s, their bones were being cleaned up and pieced back together, yielding 26 individuals with skulls complete enough to study. While their facial bones and the base of their skulls were often broken up, the backs of their heads, where the telltale signs of flat head syndrome usually occur, were largely intact. Eleven of them had an unusually flat head, with men (7) outnumbering women (4), and showing signs of flattening on their right sides more often than their left (8 versus 3). Now all that was left was to try and figure out why these skulls looked the way they did. The first task was to rule out burial damage. Since the Picenes buried their dead lying on their right side, the left side of the skull was the one subjected to the heavy weight of the soil above it. If soil pressure were to blame, the left side should have been flattened more than the right, and in the same way from skull to skull. Instead, most skulls were flattened on the right, and the affected side varied between individuals. Additionally, the skulls lacked telltale signs of being crushed while buried, such as pieces not fitting cleanly back together, or skull sutures (parts where they join up) being forcefully broken apart. It seems the flat heads developed while the skull was still soft and malleable. ### Caring for Infants in the Iron Age ![Measurements and CT scans checking how lopsided an Iron Age skull is](https://archaeologyteahouse.com/media/01a0d981-65a9-70ad-91b6-94b4e9419106/1600.webp) *a) Lines across CR53’s skull measure how lopsided it is. b) CT scans reveal flattening low on the back of the head. Credit: Beck De Lotto et al. 2026* Since the flattening would have had to occur during the first year of life, the researchers needed to rule out head binding. Many cultures the world over practiced it, from ancient Peru to the Maya, using tight bandages and boards to flatten and elongate the skull. But this practice also leaves telltale signs such as pitting of the bones, a hollow on the back of the skull, and sometimes prematurely fused growth joints, none of which were evident in the burials. Besides, no evidence exists that people of Iron Age Italy practiced head binding. So the researchers CT-scanned the skulls to see whether synostotic plagiocephaly was to blame; when the scans showed no premature fusion of the sutures, the only probable explanation left was DP. Interestingly, in modern cases of DP, baby boys are more commonly affected than baby girls, and the flattening often occurs more on the right than the left side of the head. Exactly why is unclear, but for boys, it may have to do with their slightly larger heads and higher birth weights. While the Iron Age sample is too small to draw firm conclusions, I did find the parallel interesting. Most modern cases of DP are linked to lying on the back for long stretches, which often happens in cots, strollers, and car seats. I kind of doubt Iron Age Picenes had car seats and strollers, but they may have had other things that limited movement. The CT scans revealed that in some skulls the flattening sat lower on the skull than in typical modern cases, suggesting these babies' heads may have been tilted at a steeper angle than is typical today. Things like pillows, swaddling, and cradleboards may have caused this. Sadly, no evidence of these objects survives in the archaeological record for the Picenes, but ancient art may offer clues; later Roman and Etruscan art, including terracotta figurines, shows infants tightly swaddled from head to toe, with one particular depiction showing a newborn strapped into its cradle with fabric bands, lying on its back with its head propped on a high pillow. If the parents of the Matelica infants also propped up their babies' heads on similar pillows, it could explain the flattened skulls. Another parallel appears millennia later, in the 19th-century Caucasus, where infants were bound to cradles until almost two years old; Russian doctors at the time blamed the practice for lopsided flat heads. While archaeologists have linked many cases of accidental head flattening among North American Indigenous groups to the use of cradleboards, none are known from the Picenes; however, cradles and swaddling are well documented in the later Roman world. What you may not know is that even how a baby is fed could contribute to flat head syndrome. Breastfeeding involves frequent position-swapping, so the head never really rests in one position for long. But bottle feeding or similar practices encourage a preferred head position and thus prolong the pressure on the same spot of the skull. Spouted pottery vessels with traces of animal milk from Iron Age Central Europe, and chemical evidence of babies weaned at around eight months at a roughly contemporary site in southern Italy, suggest such feeding may have been practiced at the time. With all these factors, flat head syndrome may well have been as common in the past as it is today. In fact, there is a pretty good chance that the 42% (11 out of 26 individuals) seen with flat head syndrome is an underestimation. Remember, mild cases kind of even out as you grow; it's only the more severe cases that persist into adulthood, as they did here. The rate is close to that found in a 1971 study of British children aged 10–16, where 40% were found to have flat head syndrome, long before the Back to Sleep campaign. While the variety of shapes at Matelica may suggest that a mix of customs, such as feeding, pillows, and cradles, all contributed, what linked them together was that they all restricted the baby's head movement. --- Flat head syndrome is definitely not a modern phenomenon, and the Back to Sleep campaign didn't create it; it just gave doctors a reason to look more closely at its causes. Babies seem to have developed it for millennia, with flat heads resulting from cradles, cots, car seats, strollers, and a whole bunch of other factors. But why should we care? Because if the main cause were simply back-sleeping, parents would be stuck choosing between having a baby with a lopsided head and a life-saving guideline. Back sleeping itself is fine (and remains the safest way for babies to sleep); it's hours of not moving a baby's head, whether sleeping, feeding, or doing anything else, that isn't. Babies themselves don't survive in the archaeological record much either, but an adult with a flat head gives you insights into ancient child care practices even when the babies themselves aren't present. And maybe it can help us understand our modern child care practices just a bit better. Why do you think these individuals had flat heads, and are you a 90s baby or a 90s parent, and did you have to deal with flat head syndrome in some form? *Let me know what you think, and if you'd like to support this blog and the person writing it, you can *[*chip in once, monthly, or yearly.*](https://archaeologyteahouse.com/support)* Only if you'd like to.* ### References: De Lotto, M. A. B., Zanatta, A., Zink, A., Pacciani, E., & Paladin, A. (2026). Before “Back to Sleep”: Deformational plagiocephaly and pediatric insights from Iron Age Italy. *International Journal of Paleopathology*, *54*, 48–58. [https://doi.org/10.1016/j.ijpp.2026.07.001](https://doi.org/10.1016/j.ijpp.2026.07.001) ## Common questions **How old were the people with flat heads when they died?** None were children. Two were adolescents, four were young adults (20–35), and five were mature adults (35–50). **Did any of them have neck problems?** Possibly. Seven individuals had skeletal clues that may point to congenital muscular torticollis, or wryneck, a tight neck muscle that keeps the head tilted to one side. These clues included uneven neck vertebrae and bony growths on the collarbone. Torticollis can both cause flat head syndrome and result from it, so the researchers couldn't say which came first.