Babies are born with soft skull bones to allow them to pass easily through the birth canal.
This clever design also allows for rapid brain growth in the first year of life. Soft skull plates make it possible for the head to expand constantly.
More parents notice their baby has a flattish spot that forms on the back of the head. This spot causes a lot of alarm and often leads parents to seek treatment for flat head syndrome or plagiocephaly.
Usually, this happens as a result of babies being placed on their backs for sleep and staying in this position for play and transportation during much of their early life.
In part, this is due to the increased awareness, since the 1990s, that back sleeping reduces the risk of sudden infant death syndrome (SIDS). Although back sleeping has reduced the incidence of SIDS, there’s also been an increase in flat head syndrome during the same period.
What is a flat head syndrome?
Flat head syndrome is also known as positional plagiocephaly and brachycephaly.
Positional plagiocephaly is simply when a baby’s head is misshapen, flat or uneven in shape. It usually happens because the head remains in the same position for a long time.
Brachycephaly is when the back of the head is flat and the forehead bulges as the baby’s head become wider.
I know! Sounds scary, doesn’t it? Often the baby’s hair even falls out in these areas, which leaves parents even more concerned.
How common is a flat head syndrome?
Flat head syndrome or plagiocephaly is more common than you’d think.
Researchers have found that 47% of 2 month-olds have a flat spot or plagiocephaly.
As explained in a report by the American Academy of Pediatrics, positional plagiocephaly is found in 20-50% of 6 month-old babies. Around 80% are noted within the first 4-12 weeks.
Can you get rid of flat head syndrome?
Most babies with plagiocephaly don’t need specialist treatment. A very small number of babies have severe or persistent cases that need intervention.
In severe cases, a pediatrician or doctor might recommend helmet therapy before the skull fuses. This helps to create the right amount of space for the baby’s brain to grow. Helmet therapy isn’t very common and it’s usually less scary than it sounds.
How long does a baby have to wear a helmet for a flat head?
If your pediatrician recommends the use of a helmet for plagiocephaly, your baby will probably need to wear it for about 23 hours a day for approximately 6 months.
It’s most effective when treatment starts between 6 and 8 months of age, and is finished before the first birthday. This is the time of rapid growth of a child’s skull.
The helmet is specially made and fitted for your baby. It’s designed to take the pressure off the flat area and encourage the skull to grow into the space provided.
Wearing the helmet doesn’t hurt at all, and your baby will quickly get used to wearing it.
Does a flat head affect brain development?
There is some research that suggests infants with severe cases of positional plagiocephaly or brachycephaly can be at higher risk of motor, language, and cognitive delays.
Other studies have shown the research to be limited and in need of further examination.
Although it is rare, some babies are born with a congenital condition called craniosynostosis, where the skull bones are already fused. Craniosynostosis is completely separate from flat head syndrome.
How to prevent the flat head syndrome
Prevention is better than cure. Although you want to make sure your baby sleeps safely on his back, you also want to be sure his head grows evenly.
Here are 7 tips that can help prevent flattening of the head, or treat developing flat head syndrome:
#1: Babywearing is flat head syndrome prevention
There are many reasons parents wear their babies, but not everyone is aware of how babywearing helps reduce flat head syndrome.
The more time your baby stays upright in a safe and comfortable baby carrier, the stronger the baby’s head and neck muscles become.
Being upright strengthens the neck muscles and 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 babies are awake, the changing scenery encourages them to look around, and the gentle movement will lull them off to sleep (bonus!)
Some baby carriers allow your baby to face forward (outwards). However, there are concerns about forward-facing carriers, so it’s not recommended to use them for very long periods of time.
Instead of forward-facing, a side carry in a ring sling will allow for a 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 positional plagiocephaly.
Osteopath Doctor Lauren Boundy explains:
“From my perspective as an osteopath, flat head syndrome (plagiocephaly and 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 positions in the womb 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”.
Lauren’s recommendations to reduce plagiocephaly include:
- Assessment by an experienced pediatric osteopath or chiropractor after birth
- Minimal (if any) swaddling for sleep
- Safe baby-wearing options, to enhance motion and reduce pressure on the back of the head when awake and asleep
- Caregivers alternating the way they hold babies to allow for varied postures
- The use of baby capsules for car travel only, and not for sleeping when away from the home.
#3: Change the view
If your baby spends time in the 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 colored pictures where they can be seen, and even move the cot itself occasionally, to change the view and encourage your baby’s head to move positions.
Change the baby’s sleep position regularly to reduce the pressure on one side and prevent plagiocephaly.
#4: Limit the time in seats
Car seats, transport systems, infant seats, capsules, and other equipment are all great ways to move a sleeping baby as you go about your busy day at home and away.
These seats, however, hold babies’ heads in a very limited position, and this is a contributor to flat head syndrome.
Whenever you can, leave the capsule in the car and carry your baby in a baby sling or in your arms. Choose a pram with the option of laying the seat down flat, so the baby doesn’t spend a lot of time in a semi-reclined position.
At home, choose tummy time on the floor rather than time in 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. You can sing, look at toys or books to get his attention and help him feel more comfortable on his tummy.
Place your baby on his side to look at books or toys, and vary the side he lies 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.
Tummy Time – 6 Ways To Do It (And How To Make It Fun!) has lots of ideas for you.
How does tummy time help flat head?
The American Academy of Pediatrics says tummy time is recognized as one way to reduce the time babies spend flat on their backs on a hard surface.
Not all babies enjoy tummy time, unfortunately, and parents worry a lot about what else they can do to reduce the risk of plagiocephaly.
Gradually build up the amount of floor and tummy time each day during the first few months. Even short bursts can help your child strengthen his neck muscles, lift and move his head and reduce the chance of remaining stuck in one position.
#6: Mix it up
Changing sides when breastfeeding isn’t just about accessing the other breast. Your baby’s vision, neck and arms benefit from this regular alternating of position.
If you’re bottle-feeding, your baby will also enjoy being swapped from one arm to the other during feeds.
Vary the scenery by moving the changing table or mat occasionally, to give your baby new views and interesting things to look at.
Encourage him to turn his head by positioning a mobile to one side or the other rather than directly overhead, or hang pictures on the wall at eye-level.
Once babies begin to roll, shuffle, crawl and move, they are no longer restricted to the position they’ve been placed in.
They’ll naturally turn their heads from side to side while sleeping and probably spend less time lying on their backs to play.
#7: Reach out to an osteotherapist
For a thorough head-to-toe check, look for a reputable pediatric osteopath in your area, and find out whether your baby could benefit from some bodywork to help correct plagiocephaly.
Osteotherapists are experts in infant muscles and bones and can do a thorough assessment of your baby’s skull.
Gentle exercises can be introduced to help correct plagiocephaly if your baby is starting to show signs of the condition.
Can flat head correct itself?
Plagiocephaly can definitely correct itself over time.
By following these tips in the first six months or so, parents can help keep their baby’s head shape naturally, and reduce any flattening.
How long does it take for baby’s head to round out?
Usually you will notice a change in your baby’s skull shape over a few months.
Keeping the head turned to one side and changing the head position as your baby sleeps on his back can take the pressure off one area and reduce plagiocephaly.
In most cases, by the time your child is one or two years old, flat head syndrome will barely be noticeable.
If you have any concerns about plagiocephaly, follow them up with your health care provider.