This page answers these questions on flat head infants which is known as plagiocephaly, positional plagiocephaly and deformational plagiocephaly:
Flat head infants (or flat spot on head in babies) is also referred to as plagiocephaly which describes an asymmetric head shape. The term plagiocephaly comes from Greek - oblique head. The condition is also called positional plagiocephaly.
Plagiocephaly can occur before birth - in this case this is due to the way the baby's head was positioned and molded in the uterus (womb). It will get worse after birth if your baby continues to lie on the flat spot on his head, because the skull bones are still relatively soft and malleable. Flat head infants are not uncommon because of this.
Sometimes plagiocephaly occurs after birth and flat head infants tend to lie on their heads causing a flat spot on the head. Infants can get this because there is a tightness in the neck muscle, called torticollis, or just because they are spending a lot of time lying on their backs and all the interesting things to look at are on one side of the room. Nobody likes looking at a blank wall.
I have seen a baby who spent a lot of time in a baby hammock - this caused a very obvious flat spot on the head because the hammock molds around the baby's head and there is no space for the head to remold if it is flat.
Prevention is always best and you can prevent flat head infants. Preserve your baby's symmetric head shape by:
The body will naturally remold the skull of flat head infants into a symmetric shape if it can. The flat spot on his head needs space, not pressure, to remold. To help the body do its job, it is important that the baby does not lie on the flat spot on his head, which is still relatively soft and malleable.
You can do the following to help flat head infants:
It may take 2-3 months to see an improvement in head shape. Flat head infants usually remold the skull so that the flat spot looks less obvious as they get older.
"Tummy time" refers to time your baby spends lying on his tummy - ie. the prone position. It is important for babies to have "tummy time" to develop good tone in their trunk muscles. It also gives them time when there is no pressure on their heads and flat head infants can remold their head shape. It is important that "tummy time" is supervised and that babies don't fall asleep on their tummy. Give your baby at least 5-10 minutes of "tummy time" per day.
It is important for babies to be put to sleep on their backs - this is the safest sleeping position and helps prevent sudden infant death syndrome (or crib death or cot death).
Babies just need to get used to being on their tummies. Start early by putting your baby on his tummy on your chest so he can see your face. When you put him on the floor for the first time, get down on the floor with him so he doesn't get scared. Persevere and he will get used to it - it is important for his development for him to have tummy time.
In some countries, not New Zealand or England, babies with plagiocephaly can be offered helmets to help the flat spot on the head remold. Helmets must be worn for 23 out of 24 hours daily and babies may need treatment for up to 6 months. In mild to moderate cases where there is a flat spot on the head, there is no benefit of helmets in re-molding the head shape compared to the simple re-positioning techniques outlined above for flat head in infants.
Occasionally, surgery is required. This is usually when there is abnormal fusion of the skull bones causing the flat head infants- this is called craniosynostosis. From above, the head will look like a rhomboid with craniosynostosis and like a parallelogram with positional plagiocephaly. So with fused skull bones, one side of the head will look shorter than the opposite side.
There has been a rise in the incidence of plagiocephaly since the campaign to put babies to sleep on their backs, but the cause of plagiocephaly is not sleeping on the back. However, it is aggravated by spending extended periods lying on the flat spot on the head when not asleep. If you ensure your baby doesn't always lie on the flat spot on his head, then there shouldn't be a problem.
Putting your baby to sleep on his back is absolutely the safest position for him.
Torticollis refers to a tight muscle in the neck (the sternomastoid muscle) which means the baby can't fully turn the head. There are several causes of a tight muscle in the neck (it can be the cause or the result of flat head infants), but the important thing is to give gentle stretching exercises to the muscle to prevent it shortening and tightening further.
If there is torticollis, the American Academy of Pediatrics advises the following exercises at each diaper (nappy) change:
Remember, these stretches are gentle - never force your baby's head.Sometimes, you will need to see a physiotherapist.
See your doctor for flat head in infants if:
Last reviewed on 11 November 2011
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