Flat head syndrome FAQ

October 09, 2018

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In the 1990’s, the American Academy of Pediatrics launched a campaign called “Back to Sleep.” The purpose of the campaign was to promote safe sleeping practices and help avoid unexplained, sleep-related causes of infant death. Now referred to as “The Safe to Sleep” campaign, the actions encouraged by the AAP and practiced by parents helped lower the number of sleep-related infant deaths significantly over time. Years later, research suggested the campaign had an impact on the instances of flat head syndrome in infants because it encouraged parents to put babies to sleep in a supine position, on their back; others argued that the rise in cases was due to clinicians’ increased ability to identify the condition.

Most cases of plagiocephaly, otherwise known as flat head syndrome, are harmless, as the result of flat head syndrome is simply a head that has flat spots or slight abnormalities. 

There are many factors that contribute to flat head syndrome, sleep position being one of them. This article describes ways to avoid or prevent this from happening; however, you should not put infants to sleep on their stomachs as it could increase the risk of sudden infant death syndrome (SIDS).

Infants also have a greater risk of SIDS when they co-sleep with their parents.

What causes flat head syndrome?

A baby’s skull is quite soft, and any kind of constant pressure against their skull can cause it to change shape. Consistently putting a baby to sleep in the same position means they are at a greater risk of developing a flattened skull. But cribs and mattresses aren’t the only things to consider. When putting your baby in a car seat, be sure that their head is in a neutral position to avoid their heads from flopping to one side for long periods of time.

Flat head syndrome is also common in premature babies and babies who are multiples since their heads are likely pressed together in utero.

Learn more about high-risk pregnancies and understand the possible complications of being pregnant with multiples:

Changing the sleeping position of your child is very important, as infants can also develop torticollis or “twisted neck” which contributes to flat head syndrome. This occurs if the neck muscles are injured at birth and the range of motion is limited, or if the baby prefers to sleep on one side more than the other, and the development of the neck muscles is affected.

Are there different types of plagiocephaly?

Almost one-third of babies will display some sort of positional head deformity. The most common type of flat head syndrome occurs from the positioning of the infant’s head. This is known as positional plagiocephaly and can manifest in various areas around the skull.

There are other types of positional skull deformities:

Brachycephaly is when only the back of the head is flattened, as a result of the infant sleeping on their backs.

Scaphocephaly is rarer than the other types and happens when the skull bones grow across the soft tissue, causing restricted growth of the skull. It is characterized by an elongated and narrow head.

Trigonocephaly occurs similarly, however it’s characterized by a protruding forehead and a somewhat triangular shape of the head.

Positional skull deformities are cosmetic attributes. They do not cause the volume or contents of the baby’s head to change, and they do not cause brain growth problems.

Does my baby have flat head syndrome?

If you notice that your baby’s skull looks asymmetric, consult your doctor. Check after bathing, while the baby’s hair is still wet.

Typically, an infant’s head is round and symmetrical on the sides. You can examine your infant for flat spots or abnormalities, and your doctor may have already performed this check on your last routine visit.

How can I prevent flat head syndrome in my baby?

Some ways to avoid flat head syndrome are to change the position of your baby’s head when sleeping or sitting up in their car seat, and to alternate the baby’s head position by frequently changing which end of the crib the baby sleeps on. Some babies prefer to gaze in a specific direction when they are lying down, so if you have a mobile or a crib toy nearby you can move it to adjust their gaze. Always be aware of sleeping preferences so you can rotate your baby’s head accordingly.

We also mentioned earlier that you should never put your baby to sleep on their stomach, however, when they are awake, you can apply a different practice, often called “tummy time.” Placing your infant on their stomach while they are awake encourages them to use their neck muscles to look up and promotes the strengthening and healthy development of the neck.

What about treatment for babies who already have plagiocephaly?

If you’ve ever seen a baby wearing a helmet, flat head syndrome is often the reason why. Known as cranial orthotic therapy, the helmet forces the growing bones of the skull to follow a rounded, symmetric shape. Physical therapy may be effective in treating strengthening weak muscles and changing head-turning preferences so that a helmet is not needed. Speak with your doctor to see which treatments are right for your baby.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.