When should I worry about my babys head being flat?

Congenital plagiocephaly is thought to occur by chance during fetal development. It can also run in families and is sometimes a part of inherited disorders.

According to a review published in the Indian Journal of Human Genetics, more than 180 syndromes, including Apert syndrome and Crouzon syndrome, can be associated with congenital plagiocephaly.

There are several possible causes for positional plagiocephaly:

Sleeping position

Putting your baby to sleep in the same position day after day, for example, on their back or with their head facing right or left, puts consistent pressure on the same parts of the skull.

Babies are most at risk of positional plagiocephaly in the first four months of life, before they have the ability to roll over by themselves.

It’s recommended to always put your baby to sleep on their back to reduce risk of sudden infant death (SIDS).

To reduce risk of plagiocephaly, give your baby ample tummy time while they are awake. Spending time carrying your baby, either in your arms or a carrier, instead of having them lie down for extended periods of time. A bouncer or baby seat can also help to reduce their risk.

Insufficient time spent on the stomach

Plagiocephaly is more likely the more time your baby spends on their back. Adequate tummy time while you are awake and watching them can help reduce their risk of this condition.

Your baby may cry when you put them on their tummy, but it’s important to offer several tummy-time sessions a day.

When your baby is awake, place them on their tummy atop a blanket or mat. Start with a few minutes per session, and a few sessions a day. As your baby develops more muscle strength and neck control, you can increase the session duration.

Tummy time can also help your baby to build strength and muscles necessary for rolling over, crawling, sitting up, and, eventually, walking.

Being a multiple

When womb space is tight, a baby’s skull has a greater than normal risk of being compressed. This can result in plagiocephaly.

Being preterm

Babies born prematurely have softer bones than those born at term. They are also more likely to have lengthy hospital stays where they spend much of their time lying on their backs.

Positional plagiocephaly is more common in premature babies than full-term babies.

Forceps or a vacuum delivery

These instruments put pressure on the skull and its malleable bones, which could lead to plagiocephaly.

Muscular torticollis

This is a condition in which an infant’s neck muscles are stiff or imbalanced. It’s often caused by limited space in the uterus or being in a breech position.

Reduced space in the uterus or being in a breech position makes it harder for the baby to twist their neck and move their head. That can cause them to favor one side, which may lead to plagiocephaly or another skull deformity.

Since the American Academy of Pediatrics launched its Back to Sleep campaign in the 1990s and the more recent Safe to Sleep campaign by Centers for Disease Control and Prevention, sudden unexpected infant deaths (SUID or SID) has decreased by 50 percent. Both campaigns urge parents and caregivers to place sleepy babies on their backs for sleep.

While researchers and medical providers have learned that back sleeping cuts the risk, they have also seen a simultaneous increase with babies developing a flat head, known as plagiocephaly. Plagiocephaly develops when an infant’s soft skull becomes flattened in one area, due to repeated pressure on one side of the head.

According to Banner Health Clinic family medicine physician Michael Bradfield, MD, most cases of flat head get better with time, but there are cases where repositioning programs are beneficial in treating plagiocephaly.

The Causes of Plagiocephaly (Flat Head Syndrome)

The most common type is positional plagiocephaly, which is due to pressure on the same part of the head for prolonged periods of time. This happens not only while baby is sleeping but also being in infant car seats, carriers, strollers and swings. Premature babies are more likely to have a flattened head as their skulls are softer than full-term babies and may spend more time on their backs because of medical needs, such as the NICU.

Many parents may feel immense guilt and blame over this—feeling like they could have prevented their infant’s flat spot. The truth is, most babies don’t have perfectly shaped heads. In our conversation with him, Dr. Bradfield added, “The most important thing to remember is that plagiocephaly is a reversible, nonsurgical condition, but it is important to be evaluated by a physician. While plagiocephaly will not change a child’s development or neurological outcomes a similar presentation, craniosynostosis can.”Although positional plagiocephaly is quite common, there are also congenital causes as well. Such as:

• Craniosynostosis is a premature fusion of the skull bones in a child. Occurring in about 1 in 2,500 births (including trigonocephaly, scaphocephaly, brachycephaly), this condition usually requires surgical treatment with or without helmet correction.
• Congenital torticollis, or wry neck, is due to a shortening of the muscle in one side of the neck, causing the head to tilt in one direction. This condition is corrected with intense, early physical therapy.

Diagnosing Plagiocephaly

Your child’s primary care doctor or pediatrician will check your infant’s head for features like: bony ridges, flat spots, an uneven forehead or facial asymmetry.

“Medical tests are usually not needed,” Dr. Bradfield said. “If, however, the diagnosis is not clear or if the condition does not get better with 6 months of conservative measures, your provider may refer your child to a neurosurgeon at a craniofacial clinic.”

Treating Positional Plagiocephaly

As Dr. Bradfield mentioned, most cases do get better with time, however, there are several simple practices and some treatment options.

• What You Can Do at Home
  • Provide supervised tummy time as much as possible during awake hours. Since a child’s head continues to remodel the most up to 18 months of life it is never too late to start tummy time.
  • Although it may be hard as a busy parent, hold your baby more often to take pressure of their head. Avoid letting your baby fall asleep in their car seat.
  • If you always lay your baby down in the crib or your arms in a certain direction, consider varying their position in the opposite direction.
  • Important Reminder: Continue to place baby to sleep on their back.
• Physical Therapy
  • Most babies with flat head syndrome also have some degree of torticollis. A repositioning program at home in conjunction with physical therapy can have good success in helping your baby lengthen their neck muscles and straighten their necks.
• Orthotic Helmet
  • In most cases, a helmet is not necessary. However, if you have exhausted repositioning techniques and physical therapy, your infant’s medical provider may suggest helmet therapy. If a helmet is recommended, your doctor will refer you to a certified orthotist.

If you are concerned your baby may be suffering from plagiocephaly or a similar condition, schedule an appointment with one of our Banner Health specialists at bannerhealth.com.

Join the Conversation

Flat head syndrome usually happens when a baby sleeps with the head turned to the same side during first months of life. This causes a flat spot, either on one side or the back of the head.

Flat head syndrome is also called positional plagiocephaly (pu-ZI-shu-nul play-jee-oh-SEF-uh-lee).

What Causes Flat Head Syndrome?

The most common cause of a flattened head is a baby's sleep position. Infants are on their backs for many hours every day, so the head sometimes flattens in one spot. This happens not only while they sleep, but also from being in infant car seats, carriers, strollers, swings, and bouncy seats.

Premature babies are more likely to have a flattened head. Their skulls are softer than those of full-term babies. They also spend a lot of time on their backs without being moved or picked up because of their medical needs, such as a stay in the neonatal intensive care unit (NICU).

Flat head syndrome can even start before birth if there's pressure on the baby's skull from the mother's pelvis or a twin. In fact, many babies from multiple births are born with heads that have some flat spots.

Flat head syndrome is caused by tight neck muscles that make it hard for babies to turn their heads. This neck condition is called torticollis. Because it's hard to turn their head, babies tend to keep their heads in the same position when lying down. This can cause flattening. Then, once the head has a flat spot, the torticollis (tor-ti-KOLL-iss) can get worse.

It takes a lot of energy for babies to turn their heads. So those with severe flattening on one side tend to stay on that side, and their necks become stiff from lack of use.

What Are the Signs & Symptoms of Flat Head Syndrome?

Flattened head syndrome usually is easy for parents to notice:

• The back of the baby's head is flatter on one side.
• The baby usually has less hair on that part of the head.
• When looking down at the baby's head, the ear on the flattened side may look pushed forward.

In severe cases, the forehead might bulge on the side opposite from the flattening, and may look uneven. If torticollis is the cause, the neck, jaw, and face also might be uneven.

How Is Flat Head Syndrome Diagnosed?

Doctors often can diagnose flat head syndrome by looking at the baby's head. To check for torticollis, the doctor may watch how a baby moves the head and neck. Medical tests usually are not needed.

How Is Flat Head Syndrome Treated?

Caregivers should always place babies on their back to sleep to help prevent sudden infant death syndrome (SIDS), even with possibility of flat head syndrome. Avoiding swings, car seats, bouncy chairs, and other devices is safest for sleep and also helps to make sure that babies can move their head freely.

So what can parents do when flat head syndrome is due to a sleeping or lying position? Simple practices like changing a baby's sleep position, holding your baby, and providing lots of "tummy time" can help it go away.Try these tips:

• Practice tummy time. Provide plenty of supervised time for your baby to lie on the stomach while awake during the day. Tummy time:
  • helps normal shaping of the back the head
  • encourages a baby's learning and discovery of the world
  • helps babies strengthen their neck muscles and learn to push up on their arms. This helps develop the muscles needed for crawling and sitting up.
• Vary positions in the crib. Consider how you lay your baby down in the crib. Most right-handed parents carry infants cradled in their left arms and lay them down with the heads to their left. In this position, the infant must turn to the right to look out into the room. Position your baby in the crib to encourage active turning of the head to the side that's not flattened.
• Hold your baby more often. Limit the time your child spends lying on the back or with the head resting against a flat surface (such as in car seats, strollers, swings, bouncy seats, and play yards). For instance, if your baby has fallen asleep in a car seat, take your baby out of the seat when you get home rather than leaving your little one snoozing in the seat. Pick up and hold your baby often, which will take pressure off the head.
• Change the head position while your baby sleeps. Change the position of your baby's head (from left to right, right to left) when your baby is sleeping on the back. Even if your baby moves around during the night, place your child with the rounded side of the head touching the mattress and the flattened side facing up. Don't use wedge pillows or other devices to keep your baby in one position.

Most babies with flat head syndrome also have some degree of torticollis. So physical therapy and a home exercise program usually are part of treatment. A physical therapist can teach you exercises to do with your baby involving stretching. Most moves involve stretching the neck to the side opposite the tilt. In time, the neck muscles will get longer and the neck will straighten itself out. The exercises are simple, but must be done correctly.

A doctor can prescribe a helmet for flat head syndrome. The helmet is designed to fit a baby loosely where the head is flat and tightly where it is round. In the helmet, the head can't grow where it is already round. So it grows where it's flatter.

Helmets make the head rounder quicker than time and normal growth. On average, though, babies who get helmets and those who don't have the same results after a couple years. Talk to your doctor about whether a helmet could help your baby.

What Else Should I Know?

Flat head syndrome improves with time and natural growth. As babies grow, they begin to change position themselves during sleep, so their heads aren't in the same position.

When babies can sit on their own, a flat spot usually won't get any worse. Then, over months and years, as the skull grows, the flattening will improve, even in severe cases. As hair grows in over the first few years, the flat spot often becomes less noticeable as well.

Flat head syndrome doesn't affect a baby's brain growth. But having a stiff neck can slow early development. Physical therapy for torticollis should include a check of the baby's progress and extra exercises to treat any delays.