“Flat head syndrome” is the lay term for a disorder that affects the skull, it is otherwise known as Plagiocephaly, and sometimes Positional plagiocepahly or Deformational plagiocephaly.
It is when the back or the side of a baby’s head appears flattened.
I felt compelled to write this article to explain its causes and consequences as I see so many babies who have this condition and who unfortunately are not been advised well by their Paediatricians early …. however the good news is something can be done, and it is rarely serious.
It is also incredibly common, with some reports estimating that this affects at least half of babies under one year old.
The not so good news is that Parents often wait till the baby’s skull has become harder and this in turn is harder to treat effectively
There are two types of flat head syndrome, Plagiocephaly and Brachycephaly.
Plagiocephaly is the most common one, when the head is flattened to one side, causing it to look asymmetrical and distorted, for example, when viewed from above, the head may look like a parallelogram.
Brachycephaly is when the back of the head becomes flattened causing the head to widen.
What are the causes?
Positional plagiocephaly (the clue is in the name!) is produced by pressure from the outside on the baby skull. It can occur whilst baby is in the womb, but much more commonly it occurs in the first 3 months of life.
The baby’s skull is very soft in the first few months of life and is soft and “plastic” enough to be moulded and therefore affected easily by outside pressure. So when a baby is placed for long periods on their back, such as when they are sleeping, this constant pressure affects the baby head shape.
So, without doubt, baby’s sleeping position is the main cause of this syndrome, although there may be other factors at work.
In most countries in the world there has been a campaign to put babies asleep on their backs, as doctors have recommended this to reduce the risk of Sudden Infant Death Syndrome, (SIDS), or “ cot death”, so these days new babies spend a large proportion of their life on their backs.
The usual scenario is as follows:
Should the baby’s back or one side of their head be squashed against a firm mattress, the soft bones of the skull become flattened. Once their head is flattened, it will automatically stay on the flattened side or roll towards it. This will then become the preferred side for sleeping and for resting their head during the day
So how do we remedy that?
Sound and up to date advice is that babies should sleep on their backs at night, the risk of SIDS outweighs the chance of developing plagiocephaly… so the answer is to be vigilant WHEN the baby is AWAKE!!
Here are my top tips for avoiding and helping this common problem
- Early intervention and early recognition is the key! The younger the baby it is when it is recognised and dealt with, greatly improves the chances of correcting the head shape.
- A Physiotherapy assessment with a specialist paediatric Physiotherapist, who can show you what to do to position your baby and stimulate your child, is advised. Sometimes the muscles of the neck are tighter on one side than the other, and this needs to be dealt with.
- “Tummy Time” Give baby time on their tummy for short periods each day, I prefer the “little and often” approach
- When baby is awake change their position often, hold them vertically over your shoulder, lie them on their right and left sides, switch baby from a sloping chair, to a car seat into a buggy and then carried in a sling/ baby carrier
- Change the position of toys and mobiles in their cot to stimulate and encourage them to turn their head to the non-flattened side.
- Invest in a special pillow, such as the Love Nest by Baby Moov, (made in France) or the Mimos Pillow. Your Physio will advise you on this and how and when to use it.
I cannot stress how VERY IMPORTANT early intervention is, and how the outcome is somuch more effective if these measures are followed.
Your Paediatrician may or may not notice this condition, but it will be checked for in any good development assessment. The good news is that in nearly all cases, brain growth or your child’s development is not affected, but the result is merely a cosmetic one.
There are other conditions where skull and brain growth are affected, such as Craniosynostosis, (a condition where the skull plates fuse too early). This normally requires surgery but is very different to plagiocephaly. Head circumference measurements are also important at Developmental assessments to ascertain the proper growth of the skull
Torticollis, is the sometimes related condition, when one side of the neck has tighter muscles that the other, but I shall save that for a blog on another day!
In rare and severe cases the use of Helmets or head bands may be used, but this is rarely called for.
So what is the outlook?
If you follow all the suggestions given above, head shape will usually correct itself by the time the baby is one year old. It is SO important to understand that early treatment is vital for the best outcome.
If you think your baby has tendency to look to one side or you notice any flattening, get your child seen by an experienced Paediatric Physiotherapist. They will show you all the correct positioning, and show you tips and give advice how and when to follow through. They will check for torticollis, measure the head circumference and its growth, and above all, reassure you.
If you live in Hong Kong and are concerned about your baby, please do not hesitate to contact me, even if it is just for a chat
Have fun and keep that baby moving!