Flat head syndrome, or plagiocephaly/brachycephaly, is a condition where an infant’s head develops a flattened or misshapen spot. A baby’s skull bones are soft and pliable in early life, allowing for rapid brain growth. Consistent external pressure on one area of the skull can lead to flattening. This common occurrence is generally considered a cosmetic issue, though understanding its prevalence and management is helpful for parents.
Understanding the Prevalence
Studies indicate that positional plagiocephaly can occur in up to 50% of babies, with variations in severity. The incidence of flat head syndrome increased following the 1992 “Back to Sleep” campaign. This public health initiative advised parents to place infants on their backs to sleep, successfully halving Sudden Infant Death Syndrome (SIDS) rates.
While the “Back to Sleep” campaign effectively promoted infant safety, an unintended consequence was the rise in positional head flattening as babies spent more time on their backs. However, studies on teenagers born after the campaign suggest many children outgrow the condition without intervention. Research indicates the prevalence of plagiocephaly in teenagers is significantly lower (around 1.1% to 1.3%) compared to the 20% to 48% observed in infants. This suggests that, for most, it is a temporary cosmetic concern rather than a serious medical issue.
Contributing Factors
Flat head syndrome develops from prolonged pressure on a baby’s soft skull. Infants spend many hours on their backs, especially for sleep, leading to consistent pressure on the same part of the head. This positional factor is also influenced by time spent in devices like car seats, strollers, swings, and bouncy seats, which restrict head movement.
Premature babies are more prone to this condition because their skulls are softer and less developed at birth. They often spend extended periods lying down in hospitals, contributing to head flattening. Torticollis, a condition with tight neck muscles, is another factor. Torticollis can cause a baby to consistently tilt or turn their head to one side, increasing pressure on that favored area. A baby’s position in the womb, particularly in multiple births or with limited amniotic fluid, can also contribute to head molding before birth.
Strategies for Prevention and Correction
Parents can take several proactive steps to prevent and manage flat head syndrome. Repositioning techniques are a primary method, involving gently changing the baby’s head position during sleep and awake periods to distribute pressure evenly across the skull. When placing a baby in a crib, alternating the direction their head faces each night encourages them to turn their head towards different points of interest, varying pressure points. Always place babies on their backs for sleep to reduce SIDS risk, but their head position can be varied within this safe guideline.
“Tummy time” is another effective strategy for both preventing and correcting flat head syndrome. This involves placing the baby on their stomach for supervised play while awake. Tummy time relieves pressure on the back of the head and strengthens neck, shoulder, and upper body muscles, important for head control and motor development. Aim for short, frequent sessions, gradually increasing duration as the baby gets stronger, aiming for at least 30 minutes total daily.
Limiting time infants spend in devices that fix their head position, such as car seats, swings, and bouncers, can also help. Holding the baby often and varying feeding positions encourages different head movements. If conservative measures like repositioning and tummy time do not improve head shape, or if there is underlying torticollis, a healthcare provider might recommend physical therapy. In moderate to severe cases, a doctor may suggest a cranial remolding helmet, which gently reshapes the skull as the baby grows. Helmet therapy is most effective when started between 4 to 6 months of age, during rapid head growth.