When a baby’s head appears flattened, parents often wonder about the causes and solutions for flat head syndrome. This condition, also known as positional plagiocephaly or brachycephaly, involves a flattening on one side or the back of an infant’s skull.
Understanding Flat Head Syndrome
Flat head syndrome primarily encompasses two types: plagiocephaly and brachycephaly. Plagiocephaly involves an asymmetrical flattening on one side of the head, which can cause the ears to misalign and the forehead or face to bulge slightly on the flattened side. Brachycephaly refers to a symmetrical flattening across the back of the head, sometimes resulting in a wider head and a bulging forehead. These conditions are common, affecting around one in five babies at some point.
The primary cause of positional flat head syndrome is sustained pressure on a specific area of the infant’s soft skull. This often occurs because babies spend a lot of time lying on their backs, which is recommended to reduce the risk of Sudden Infant Death Syndrome (SIDS). Other contributing factors can include a baby’s position in the womb, premature birth (as their skulls are softer), or torticollis, a condition where tight neck muscles limit head movement and cause a preference for resting the head in one position. Positional flat head syndrome is generally considered a cosmetic issue and does not affect brain development or cause brain damage.
Common Treatment Approaches
Addressing flat head syndrome typically begins with non-invasive methods. Repositioning techniques involve changing the baby’s head position during sleep and while awake to relieve pressure on the flattened area. This can include alternating the direction the baby lies in the crib or varying how the baby is held and fed. Increased supervised tummy time is another widely recommended approach, as it strengthens neck and shoulder muscles while reducing time spent on the back.
Physical therapy can be particularly helpful, especially if torticollis (tight neck muscles) is present. A physical therapist can teach exercises and stretches to improve neck muscle flexibility and encourage a wider range of head motion. If these initial strategies are not sufficient, a cranial orthosis, commonly known as helmet therapy, may be recommended for more significant flattening. These custom-fitted helmets apply gentle, consistent pressure to reshape the skull as the baby grows, fitting loosely where the head is flat and snugly where it is rounded. Surgery is an extremely rare intervention, reserved for cases of craniosynostosis, a different condition where skull plates fuse prematurely.
The Critical Window for Intervention
The effectiveness of interventions for flat head syndrome depends on the infant’s age, as the skull is soft and rapidly growing during the first year. Repositioning techniques and increased tummy time are most effective when started early, from birth up to around 4 to 6 months of age. Consistent application helps redistribute pressure, allowing the skull to round out as it grows. If these early, conservative measures do not improve the head shape, or if the flattening is moderate to severe, helmet therapy may be considered.
Helmet therapy is typically most effective when initiated between 4 and 8 months of age. Rapid head growth during this period allows the helmet to guide the skull into a more symmetrical shape. Studies show that starting helmet therapy before 24 weeks (around 5.5 months) significantly increases the success rate; success rates for mild-to-moderate cases were 83% when treatment began before 24 weeks, decreasing to 40% after 32 weeks.
Helmet therapy’s effectiveness decreases significantly after 12 to 18 months as skull bones harden and head growth slows. While minor improvement might still occur naturally or with continued repositioning beyond this age, significant reshaping with a helmet is not possible. By 14 months, it is too late for substantial correction through helmet therapy, and any remaining deformity may become permanent.
Potential Long-Term Considerations
If flat head syndrome is not fully corrected, the primary long-term consideration is the persistence of cosmetic asymmetry. This can include a noticeable flattening on one side or the back of the head, or uneven facial features such as misaligned ears or a bulging forehead. While positional flat head cases typically do not cause serious health issues or affect brain development, the cosmetic appearance can sometimes lead to practical difficulties later in life.
For example, individuals with significant head asymmetry might find it challenging to properly fit glasses or protective headwear for sports. There can also be psychological impacts, as a misshapen head may contribute to feelings of self-consciousness or social difficulties. Some research suggests a possible association between flat head syndrome and developmental delays, particularly in motor skills, though the relationship is not fully understood.
Preventing Flat Head Development
Preventing positional flat head syndrome involves several strategies. Maximizing supervised tummy time during waking hours is a primary recommendation, as it strengthens neck and upper body muscles and reduces pressure on the back of the head. Aim for at least 30 to 60 minutes daily, broken into short segments.
Varying the baby’s position is important. Alternate the direction the baby lies in the crib each day to encourage them to turn their head towards different stimuli. Change the arm used for feeding and vary carrying positions to promote symmetrical head movement. Limiting the time infants spend in carriers, swings, and bouncy seats can help, as these devices can keep the head in a fixed position, increasing pressure on the back of the skull.