Underneath the wonderful-baby-smelling head is a skull that is very soft, and the bones can be affected when pressure is applied to it. Even though many of you might not have heard the term ‘plagiocephaly’, you but must have heard about ‘flat head syndrome’, which is quite common in newborns and is something that will recover on its own within a few months. So, though it might raise a flag for new or first-time parents, it is actually nothing to worry about.
Plagiocephaly or Flat Head Syndrome is commonly caused between 6 weeks and 2 months old and will resolve itself completely by the age of 2 years. There are three types of plagiocephaly – positional plagiocephaly, Brachycephaly, and Scaphocephaly (more serious than the other two). Flat head syndrome happens due to many reasons like baby’s head is tilted on one side constantly, or her head might be little misshaped during pregnancy in case of twins or when she was squished out through the narrow birth canal or when the baby lies on a bouncer, swing, stroller or a car seat for a prolonged time.
Symptoms of a flat head are quite visible with the baby’s head being flat on the side or the back, misalignment of the ears or eyes. Prevention is what should be focused on than treatment; you can avoid your baby having a flat head by changing the position of their head constantly. If they have a preference, make sure to not keep their head in the same position for a long time. Increase tummy time sessions, and you can also buy pillows that are specifically made to avoid the baby having a flat head. If the case gets severe, medical treatment like a helmet, or physical therapy or even surgery is suggested. The flat head syndrome is not a matter of concern, but if you’re tensed about your baby having flat spots, then consult your doctor about it on the next visit.
What is Plagiocephaly or Flat Head Syndrome?
Plagiocephaly, pronounced as play-jee-oh-SEF-uh-lee, aka flat head syndrome, is when a baby’s head shape is asymmetrical by being flat on one side or the back. It typically appears before the baby is 20 weeks old or sometimes even before birth, and can considerably affect the shape of the baby’s head.
Babies should sleep on their back in their crib, according to the American Academy of Pediatricians (AAP), to avoid the risk of Sudden Infant Death Syndrome (SIDS). Due to this, the risk of SIDS has decreased by 50%, but this has also increased the number of infants with the flat head syndrome.
A baby’s head is soft and hasn’t hardened until many months after their debut in this world. The soft bones in your baby’s head help her go through the narrow passage of the birth canal during delivery and give ample space for the brain to grow. The soft bones can also mean that the shape of the head is likely to change if the baby is constantly lying on his back or her head is always tilted to one side.
Almost for 20% of the babies, the deformity in the skull occurs in the womb itself or during delivery.
Types of Plagiocephaly
Also known as deformational plagiocephaly, positional plagiocephaly is the most common type occurring in newborns and infants, and according to AAP, nearly 50% of the babies are affected by this. It is caused at one side of the head-left or right side by constant pressure from the crib mattress. As baby’s head is soft and if her head is tilted to either side constantly, this is bound to happen.
One ear maybe a little forward than the other, an eye might be smaller than the other, or a cheek may seem fuller than the other.
Pronounced as brack-ee-SEF-uh-lee, this type of plagiocephaly happens on the back of the baby’s head. The only and noticeable difference between position plagiocephaly and brachycephaly is that the latter typically occurs when the baby is constantly lying on her back, facing the ceiling. So, instead of either side, the back of the head flattens from the pressure and makes the head asymmetrical.
In the case of brachycephaly, the head of the baby may seem wider or taller than before, and the tips of the ear may stick out.
This type of plagiocephaly is pronounced as skaf-o-SEF-aly. This is uncommon in babies, but it is a more serious condition as it restricts the growth of the skull. Scaphocephaly is when a baby is born with a birth defect where the bones of the skull (cranial sutures) have joined or fused together prematurely, preventing normal growth. Babies with this condition have a narrow head that doesn’t grow from side to side.
Scaphocephaly is also known by Craniosynostosis, or congenital plagiocephaly is a rare birth defect. It is known that this occurs in 1 out of every 2,000 to 2,500 births.
If a severe case of plagiocephaly is left untreated, then your baby can have…
- Balance issues
- Delay in speech and language development
- Asymmetrical face with uneven eyes or ears or sides of the head
- Delayed motor and intellectual development
- Social interaction issues
Symptoms of Flat Head Syndrome
The flat head syndrome is usually easy for the parents to notice. You can check whether your baby has a flat head syndrome by touching the back and sides of the head.
Do this when you bathe them, and their hair is wet; this will help you in determining more clearly if there are any flat spots on your baby’s head.
What signs should you check for a flat head syndrome?
- Flat area on the back or either side of the baby’s head instead of being round.
- Your baby has a strong preference to one side and has difficulty in turning her head to the other side.
- Head seems asymmetrical when you look from the top or a side view.
- Alignment of ears is uneven.
- There is no soft spot (a fontanel) on baby’s head.
In severe cases, you might even notice the forehead of the baby bulging out on the side opposite from the flattening.
Causes of Plagiocephaly (Flat Head Syndrome)
Baby’s head is like the thicker version of slime (the slimy toy product that kids these days are obsessed with); it will flatten on the bottom if kept in that position for a prolonged time.
The main causes of the flat head syndrome are…
Sleeping position of the baby
Babies are the most at risk of having a flat head in the first 4 months of life, after which, they develop the milestone of rolling over on their stomach.
The position the newborn or an infant is sleeping determines on which side a flat area can occur. As discussed before, if she is more inclined to tilt to a particular side, she’ll have a flat are on that side, and if she’s constantly sleeping on her back (good to avoid the risk of SIDS) can make the back of her head flat.
Also, if the baby gets very limited time on their stomach and lies flat on their back for most of the day, then it is obvious that the constant pressure from the mattress or the floor is going to create a flat spot on the back of their neck.
Baby lying in a bouncer, swing or a car seat for a long time
Similar to the crib mattress, bouncer, swings, car seats, and strollers will make the baby lie in a static position, and if kept there for a long time will cause a part of her head to flatten or misshapen.
If you’re having twins or triplets, chances are they might be born with plagiocephaly because of the lack of room and the heads being cramped and pressed up together. It can also happen if the mother has less amount of amniotic fluid inside the womb to cushion the child.
Your baby can have a flat head if you had a difficult delivery, and the baby’s head shape can change if a vacuum or forceps have been used. The pressure put on the skull while going down the trip through the birth canal can also make the baby’s head elongated.
Premature babies are more likely to develop a flat head as they will be under supervision in the hospital for days after their birth and their soft skull might be placed to one side.
They might even prefer to rest their head on one side as they won’t be able to move their head themselves in those early days.
Also known as ‘twisted neck’, Torticollis, pronounced as tor-ti-KOLL-iss, happens when baby’s neck muscle forces the head to turn to one side. This can either happen as an injury at birth or when the baby prefers a particular side, and restricts other muscle development.
Because the muscles are stiff, the baby will tend to keep their heads in the same position causing flat areas. If the baby’s head has flat spots, Torticollis is likely to get worse.
It takes a lot of energy from the babies to turn their head from one side to another, so they prefer to rest their head on one side, causing the neck muscles to tighten. So, make sure to change their head position frequently.
If the baby has Torticollis, then the jaw, neck and face might even look very uneven.
How is Plagiocephaly (aka Flat Head syndrome) diagnosed?
During your baby’s regular check-up, doctors will diagnose flat head syndrome by feeling and checking the baby’s head, particularly along the suture lines. Your baby’s head measurements will also be taken to see if the condition is serious or not.
If the doctor suspects the baby has Torticollis, he will inspect how the baby turns her head from side to side. Usually, medical tests are not needed to diagnose the flat head syndrome.
Which children are more at risk of Flat Head Syndrome
A baby is more likely to have flat head syndrome –
- If the baby had a difficult birth with the help of vacuum or forceps.
- If the baby is a first born.
- If the baby is a boy.
- If the baby has Torticollis.
How to prevent Flat Head Syndrome
There are many ways that parents can do at home to prevent flat head syndrome like
Plenty of tummy time in a day will keep the flat head syndrome away (cliché much?). But, it’s true, tummy time helps strengthen neck and shoulder muscles; these muscles will later help in crawling and sitting. Tummy time will help the flat head syndrome from getting any worse and will slowly resolve itself.
Your baby may get cranky or cry during tummy time, but remember that it is important for her growth and development. Aim for a good 10-15 minutes in the beginning and gradually increase to 30 to 60 minutes in a day. As your baby grows and develops more muscle strength, you can increase the tummy time duration. It will also encourage baby to learn and discover more.
If your baby is lying on the mattress or the floor, encourage your baby to turn their head. For instance, place your baby’s head on the left and encourage her to turn her head to the right by distracting her with toys or playing with her, and then do the same with the other side.
Limit time on a flat surface
While travelling or placing your kiddo in a bouncer, limit the time they are kept in it or again try to switch their head positions if their head is in a static position.
Consult your doctor if you think your baby’s neck muscles are tight by constantly holding her head in one position. Massage your baby’s neck gently if the pediatrician has recommended so.
Hold them often
Carry and hold your baby more often to limit their time lying flat on their back. This will take off the unwanted, extra pressure from the back of their head.
Change baby’s sleeping position in the crib
If your baby has a preference to keep their head to one side, then change their head position in their sleep from left to right and from right to left. Place them in a way where the flattened area is facing up and the round area in on the mattress.
Make sure not to use wedge pillows or other supporting pillows to make your baby sleep in one position.
Helmet or a Headband
A doctor may even prescribe a helmet if the case of plagiocephaly is severe. The helmet is supposed to loosely fit a baby’s head where it is flat and tightly fit where it is round. Helmets help fasten the recovery process than it usually takes to resolve naturally.
If you think your baby has a flat head, then consult the doctor to know whether a helmet could help your baby. Remember that there is no current evidence whether helmet or a headband helps improve your baby’s head shape.
But, the downside of helmets is they can be very expensive, and they are to be worn for up to 23 hours a day for 6 to 24 weeks. There’s also a possibility of your child being uncomfortable and cranky when the helmet is on, and there’s a risk of causing sores on the head. The healthcare provider will have to check your baby’s head every 6 weeks to determine that the helmet is allowing the brain to grow and not restricting it.
Sometimes the doctor may ask you to include physical therapy for your baby. In this case, a physical therapist will teach you different exercises that you can do at home with your baby, which involves stretching.
The physical therapy will include stretching the neck opposite to the flat area of the baby, and with time the neck will get longer, and it will straighten itself out. Make sure you understand the exercise and perform it correctly.
When does the flat head syndrome go away?
The flat head syndrome can resolve itself by the age of 2 years.
Remember, as, and when the baby starts sitting, crawling, and walking, the flat head syndrome will resolve on its own as the baby doesn’t spend the majority of her time lying on her back.
Can flat head syndrome lead to any complications?
Positional plagiocephaly is considered normal in babies, and it doesn’t affect brain development. Most of the plagiocephaly cases (except Craniosynostosis) get better with time when the baby starts sitting, crawling and walking.
A recent study which measured the head circumference of 200 babies concluded that the chances of plagiocephaly in babies are –
- 16% at 6 weeks
- 19.7% at 4 months
- 6.8% at 12 months, and
- 3.3% at 24 months
The percentage above tells us how the flat head syndrome itself resolves with time and age of the growing baby, and her hair will camouflage any tiny flat areas later.
Flat head syndrome becomes severe if your baby’s doctor suggests surgery. But, it usually happens if your baby has craniosynostosis where surgery can help relieve the extra pressure in the skull and allow the brain to grow normally.
Having surgery for severe cases can reduce the risk of complications like blindness, seizures, major developmental delays and other medical conditions.
When to seek medical advice?
If you think that your baby has a flat spot on her head, then it’s a good idea to consult your baby’s pediatrician. The doctor can check your baby’s head and possibly rule out craniosynostosis and will monitor your baby’s head over the next few visits to see how the shape of the head changes.
If the flat head doesn’t start to improve on its own, then the cause of it is different, indicating a more serious case (like craniosynostosis), and the doctor might want to run additional tests, scans, x-rays, or a CT scan. Your baby might then be referred to a pediatric neurosurgeon or a craniofacial plastic surgeon.
One in five babies has flat spots on their heads but is improved when they grow without any treatment. A slightly flattened area is not a concerning matter, but in severe cases the doctor might suggest a helmet or a headband or maybe even surgery.
Although it can be very concerning, especially for new parents, flat head syndrome or plagiocephaly is not a matter of concern as it improves with time and natural growth.
Over coming months and years, your little one’s skull will develop, which will help the flat areas be more rounds, and as hair grows over the years, the flat areas will become less noticeable.
Remember, that positional plagiocephaly doesn’t cause any hindrance to baby’s growth, but stiff muscles can so make sure to consult your doctor if you notice your baby having a flat head.