As babies turn one year old, their skull begins to harden. Any mild head deformities not fixed before their 1st birthday can be harder or take longer to correct. Although possible in rare cases, surgery can be performed to fix the residual deformity. However, not many surgeons may recommend surgical intervention because of its potential danger. If you notice that your baby has a flat head, some tummy time and repositioning will do so much to improve the condition.
Depending on the severity, a flat head syndrome in babies can be corrected, or not at all. Most of the mild conditions will improve on their own through some harmless repositioning tricks.
The severe flat head will sometimes improve through therapy. But if the baby has torticollis, a condition that restricts neck movement, it can get difficult to treat the misshapen head.
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What is flat head syndrome?
A flat head syndrome is observed when the baby’s head is flatter at the back or on one side. Misalignment of the ears and eyes is also detected in some cases.
It is a painless condition that babies acquire mostly because of their sleeping position. Flathead due to position occurs in almost 50% of newborn babies, according to the American Academy of Family Physicians.
A newborn’s skull is soft and pliable to make it easier for them to pass through the birth canals. It is not fully fused for a few more months after birth. And since it is soft, it means that the baby’s head shape can change because of sleeping positions.
Medically, the condition is called plagiocephaly, and it comes in two types: positional or congenital.
Positional or deformational plagiocephaly
The positional flat head is the most common and easily corrected plagiocephaly in babies. It spiked in the 1990s after the launch of the Back to Sleep Campaign intended to reduce the occurrence of SIDS.
The program encourages parents to put babies to sleep in the safest position – by their backs. But sleeping in the same position and lying for a long time will eventually cause the soft skull to misshape itself.
The baby’s position in the uterus can also risk flat head syndrome. As the fetus grows older, it becomes cramped up in the mother’s uterus. Ideally, babies will assume cephalic presentation in preparation for birth.
It means that he is head-down, facing the mother’s back and back of its head by the pelvis. But not all babies assume this perfect birth position, and the womb pressure can deform them. Sometimes, in multiple births, the fetuses are also in danger of developing KISS Baby Syndrome.
Other causes of positional plagiocephaly are:
- Multiple births
- Preterm birth where babies spend time lying in the hospital bed
- Insufficient tummy time
- Sleeping position
- Assisted delivery (forceps or vacuum)
- Torticollis or twisted neck
Torticollis is a neck muscle condition, either congenital or due to injury, that causes the baby’s head to tilt down. It is also called “wry neck,” where the limited neck activity also results in a flat head syndrome.
Congenital plagiocephaly or craniosynostosis is a rare birth defect that happens in the womb before the baby’s brain is fully-formed.
It occurs when the baby’s skull bones, which are supposed to fuse gradually after birth, happen in the womb. The part of the skull that has fused will stop growing, causing the misshapen head.
According to the CDC, one in every 2,000 babies is born with a congenital flat head.
How to fix flat head in babies
Babies’ skulls will not fully fuse until around 18 months of age. The fontanelle, or the soft spot on the back part of the head, will close in around 2 months. Anterior fontanelle, or those on the top of the head, will close in around 9 to 18 months.
During this time, fixing a flat head is easier done through the following methods:
Plenty of tummy time
The sooner you start with tummy time for your healthy and full-term baby, the better. It not only treats positional flat head but will also help strengthen their neck muscles.
Simply putting your baby up against your chest constitutes tummy time. Hold your baby in this position and without pressure on the flattened side of the head.
Changing the child from his preferred side will help manage flat head in babies. Put your baby on his back and gently turn his head to the side that is not flat. You may place a toy on this side to catch his attention and encourage him to turn to his non-preferred position.
Having babies to sleep on their backs is still the safest sleep position. You may also practice counter-positioning when the child is asleep but only under close supervision. Also, do not keep anything like a pillow to hold his head in place. It may block your baby’s face and risks suffocation.
Neck stretching exercises
This activity needs the doctor’s approval and expert direction. Do not try to engage your child in any stretching activities that you see on the internet.
Stretching exercises are ideal for babies with torticollis to strengthen their neck muscles. It will involve a series of exercises to increase the range of motion of the baby’s neck.
Holding the baby upright
Mild deformation can be fixed and prevented by limiting your child’s lying on their backs. So, when your child is awake, take time to get him off the crib and give him more cuddle time.
When your baby is old enough to sit, letting him in an upright position will take much pressure off his back.
Molding helmet band therapy
One of the successful methods of fixing moderate to severe flat heads in babies is using a medical helmet. The helmet or band is doctor-prescribed and custom-molded for the baby to wear.
It aids in the symmetrical re-formation of the misshapen skull. This therapy is applicable in babies between three to six months of age and may last for up to 12 weeks of treatment.
Surgery is only necessary in congenital plagiocephaly, but it is only applied in rare cases.
When the sutures in the skull have closed, it will put too much pressure on the baby’s brain. Thus, doctors may perform an invasive procedure to release the pressure.
When should I worry about a flat head?
Your baby’s head distortion is serious, and you will need medical advice if:
- He does not have soft spots on the head
- There are hard edges along the ridge of the skull
- The baby’s head is not growing
- He has uneven facial features
- Baby has seizures
- Bulging spots in the head
- Difficulty in moving eyes upward
Untreated flat head syndrome
A non-severe flat head syndrome is painless and will not affect a baby’s brain development. However, if you cannot treat the baby’s flat head, it can affect his psychosocial life later on.
They may feel socially alienated and the point of jokes from other children because of their physical differences.
As an adult, it will also limit the leisure and sports activities they can participate in, especially those involving protective headgear.
Can flat head in babies be prevented?
Alternating your baby’s position while lying, sleeping, or feeding will prevent the occurrence of positional plagiocephaly. Holding them in an upright position whenever possible will also help.
There are mattresses or pillows available that they can use, provided it is used under rigid supervision.
When does a flat head get apparent?
In some infants, especially those born via assisted delivery (vacuum or forceps), you will instantly notice the flathead. But signs of plagiocephaly get more obvious when babies are about 6 to 8 weeks old.
A medical helmet band needs a doctor’s prescription. Will my GP or pediatrician be able to give one?
If your doctor notices serious head deformities, he may refer you to a neurosurgeon. A pediatric neurosurgeon can give the prescription for helmets. Expect that you will be referred to an orthotist for the measurement, fitting, and customizing of the band.
Will my child be using the same helmet throughout the treatment?
Babies grow quite quickly, so do their heads, and may need adjustment of the helmets every 1 to 2 weeks. The foam lining or the plastic outside of the helmet will be readjusted. If he outgrows the current one, a second helmet will be recommended.
Is it possible to correct the baby’s flat head after 18 months?
A medical helmet may still fix a baby’s flat head, but the treatment will take longer. On average, younger infants will use the helmet only for about 12 weeks.
Plagiocephaly is becoming increasingly common in infants for various reasons. Conservative treatments at an early age can still revert the condition.
The mild flat head will resolve on its own with some simple practices. Even severe cases can be corrected using a medical helmet while the child’s skull is still soft. Otherwise, they may grow with misshapen heads that will only affect their self-esteem later in life.