Flat head syndrome, medically known as deformational plagiocephaly or brachycephaly, is a common physical condition that often causes worry for new parents. This flattening of an infant’s soft skull is usually noticeable within the first few months of life. The condition arises from external pressure on the malleable skull bones during a period of rapid brain growth. Understanding the medical reasons behind this change provides clarity regarding a child’s well-being.
Understanding Positional Head Flattening
Positional head flattening is categorized into two main types based on the shape of the flattening. Plagiocephaly is characterized by asymmetrical flattening on one side of the back of the head, which can cause the ear and forehead on the same side to shift forward. Brachycephaly involves symmetrical flattening across the entire back of the head, often leading to a wider-than-average skull shape.
The most frequent cause is prolonged positional pressure on the back of the head, especially since the introduction of the “Back to Sleep” campaign. This campaign recommends supine sleeping to reduce the risk of Sudden Infant Death Syndrome (SIDS). While this safe practice has lowered SIDS rates, infants spend more time on their backs, placing consistent pressure on the soft, rapidly growing skull. Contributing medical factors can also increase the likelihood of developing a flat spot, such as Torticollis, which involves tight neck muscles causing a preference for turning the head to one side. Other risk factors include a restricted position in the womb, multiple births, and prematurity, as premature infants have softer skulls.
Debunking the Link to Parental Neglect
It is a common source of anxiety for parents to wonder if positional head flattening suggests a failure in their care, but this is not the case. Positional plagiocephaly and brachycephaly are common, affecting up to nearly half of all infants to some degree. The condition is a result of necessary safe sleep practices combined with the natural malleability of a young infant’s skull, not a sign of inattentive parenting.
The increase in cases correlates with the success of the “Back to Sleep” campaign, showing that the flattening is generally a benign, mechanical consequence of prioritizing safety. In nearly all instances, the flattening is categorized as deformational or positional, meaning it is caused by external forces and does not affect brain development. A different, rare medical condition called craniosynostosis involves the premature fusion of the skull plates, which can impact brain growth and requires specialized medical intervention. This is a congenital condition with a distinct cause from positional flattening and is not related to a child’s care environment.
Effective Prevention and Treatment Steps
The primary strategy for preventing and treating positional head flattening involves simple, non-invasive repositioning techniques. The most important preventative measure is incorporating “Tummy Time” into the baby’s daily routine while they are awake and supervised. This activity removes pressure from the back of the head and helps strengthen the neck and shoulder muscles necessary for head control.
Parents should begin Tummy Time shortly after birth, aiming for short, frequent sessions throughout the day and gradually increasing the duration to a total of 15 to 30 minutes daily by the age of seven weeks. Repositioning during awake periods is also effective, such as alternating the direction the baby is placed in the crib to encourage turning their head to both sides. Reducing the time spent in carriers, swings, and car seats outside of travel minimizes pressure on the skull.
For more noticeable or persistent flattening, a healthcare provider may recommend physical therapy, especially if Torticollis is a factor, to stretch the tight neck muscles. In moderate to severe cases, a cranial orthosis, or helmet, may be prescribed to gently redirect the skull’s growth into a rounder shape. Treatment is most effective when initiated between three and nine months of age, taking advantage of the rapid cranial growth during this period.