Babies are born with a soft skull, which allows the head to adjust as needed, in order to pass through the birth canal. This ‘design’ also allows for rapid brain growth in the first year of life – soft bones makes constant expansion possible.
The ‘Back to Sleep’ approach to SIDS prevention was introduced in the 1990s, after research confirmed other sleeping positions increased the risk of SIDS. Back to Sleep has been embraced around the world, and has successfully reduced the incidence of SIDS.
However, the incidence of ‘positional plagiocephaly’ — or flat head syndrome — has risen as babies spend so much time on their backs during sleep, play and during transport (prams, car seats etc.).
Researchers have found that 47 percent of 2 month-olds have the condition.
Tummy time is recognised as one way to reduce the time babies spend flat on their backs on a hard surface. But not all babies enjoy tummy time, and parents worry about how else they can reduce the risk of Flat Head Syndrome.
Here are 6 tips that can that can help prevent flat head syndrome:
#1: Babywearing Is Flat Head Syndrome Prevention
There are many reasons parents wear their babies, but not everyone is aware how babywearing helps reduce flat head syndrome. The more time your baby spends upright in a safe and comfortable baby carrier, the stronger their head and neck control becomes. Being upright strengthens their core and is naturally a position babies enjoy. Wear your baby as you go about routine tasks like vacuuming or mopping, grocery shopping, hanging out laundry or doing the dishes. While awake, the changing scenery will encourage him to look around, and the gentle movement will lull him off to sleep.
Some baby carriers allow your baby to face forward (outwards), and this might seem an ideal way to help him. However, there are concerns about forward facing in carriers, therefore some manufacturers recommend babies only do so for 10-15 minutes at a time. Babies can be overwhelmed by too much stimulation when facing outwards, and the wearer is not able to easily see if the baby needs some quiet time.
Babies around 4-6 months haven’t yet developed the ability to screen out too much stimulus, and can become overwhelmed. Instead of forward facing, a side carry in a ring sling will allow full view of the world but also a safe retreat to mama when needed.
#2: Look At Your Baby’s Whole Body
It's important to look beyond the physical appearance of a baby with flat head syndrome.
Osteopath, Doctor Lauren Boundy, explains:
“From my perspective as an osteopath, flat head syndrome (plagiocephaly or brachycephaly), is all about the movement available in the body, not just the head or neck.
A whole body assessment to check for ease or limitation of movements is probably the most important preventative tip I would suggest. This is because awkward in-utero positions can lead to muscle imbalances if the neck, torso or shoulders are twisted unevenly. Birth efforts and duration can also add to this mechanical asymmetry. The use of vacuum or forceps, or manual extraction (e.g. during c-sections) can also add stress, particularly to the head and neck. Typically the sternocleidomastoid muscle is blamed, but osteopathically we must know WHY and HOW this occurred in an infant in order to help correct it.”
After birth, there is a gentle integration into movement and lengthening in the body. The body needs to be able to move freely and symmetrically for all systems to function optimally. Restricted neck motion, or a rotation strain through the torso requires gentle lengthening and enhancing of full motion range in order to resolve. It's also important to check for tongue tie and lip tie, as they may also restrict cranial (head) motion. If these asymmetries or restrictions are removed, and full motion encouraged, a flat head is less likely to occur.
Lauren recommends an assessment by an experienced paediatric osteopath or chiropractor after birth; minimal (if any) swaddling to sleep; safe baby-wearing options to enhance motion and reduce pressure on the back of the head when awake and asleep; care-givers alternating positions in which they hold babies to allow for varied postures; and using baby capsules only for car travel.
#3: Change The View
If your baby spends time in his or her cot before sleeping, vary the position you place your baby in, to encourage turning of the head in different ways. Hang a mobile above the cot, put brightly coloured pictures where they can be seen and even move the cot itself occasionally to change the view.
#4: Limit Their Time In Seats
Car restraints, transport systems, infant seats, capsules and other portable equipment are all great ways to move a sleeping baby as you go about your busy day at home and away. However, the limited position that these seats hold babies heads in is also a contributor to Flat head Syndrome. When you can, leave the restraint in the car and carry your baby in a baby sling or in your arms. Choose a pram which has the option to lay the seat flat, rather than only hold the baby in a semi-reclined position. At home, choose playtime on the floor over bouncers and baby seats.
#5: Get Down On The Floor With Your Baby
Encourage your baby to enjoy tummy time by lying on the floor with him. Bright toys and books, your voice singing songs or chatting to him and knowing he has your attention, will all help him become more comfortable on his tummy. But also, lay him on his side to look at books or toys, and vary the side you lay him on. Lying on your back, tummy to tummy with your baby, can also be fun. There are even exercise programs you can do with your baby which incorporate tummy play that is enjoyable for both of you.
#6: Mix It Up
Changing sides when breastfeeding is not just about accessing the other breast – your baby’s vision, neck and arms benefit from this regular alternate position. If you are bottle feeding, your baby will also enjoy being swapped from one arm to the other during feeds. When changing nappies, you can vary the scenery by occasionally moving the change table, putting the changing mat on the floor or other surface, or taking advantage of the view through a window, while you attend to your baby. Encourage him to turn his head by positioning a mobile to one side or the other rather than directly overhead or put pictures at eye-level on the wall.
Once your baby begins to roll, shuffle, crawl and move, he will no longer be restricted to the position you put him in. He will turn his head from side to side while sleeping, and will probably spend less time lying on his back to play. By introducing these tips in the first six months or so, you can help his head naturally keep its shape and reduce any flattening. If you have any concerns, consult your health care provider.
To learn more about Tummy Time, read BellyBelly’s article Tummy Time For Baby – How To Make It Fun!