Flat Head in 2016: What It Is, How to Prevent It

What does it mean when a baby has a flat head?

You may have noticed a lot more babies with flat heads these days. There’s a good reason for this. It’s a result of The Law of Unintended Consequences. Like when there’s a massive public health effort to reduce the incidence of Sudden Infant Death Syndrome (SIDS), and pretty soon there’s a lot of babies out there with flat heads as a result? That’s what I mean by “unintended consequences”.

The good news is that flat head syndrome is a minor problem compared to SIDS. The better news is that it gets better with time. Here’s all you need to know about it:

What is “Flat Head Syndrome”?

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How it happens

Everything in medicine has to have a name carved out of Latin and Greek in order to confuse us. Flat head syndrome is no different. Doctors know it as “Positional Plagiocephaly“. Plagiocephaly means “oblique head”. Put together, the term refers to baby heads that are slanted on one side because of the way the baby lays down.

When babies lay on their backs for too long, particularly with their heads to one side, as shown, they have a tendency to get flat on that side. This is because the space between the bones of the baby’s skull allow for the head to change shape fairly easily. This is a good thing when a brain is growing fast! But it can also lead to flat head. The flatter a head gets on one side, the more likely it is that the baby will favor that side, because it’s harder for her to turn her head!

Premature babies are more likely than full-term babies to develop flat head, as the bones of their skulls are softer. Sometimes babies develop flat head before birth, particularly if conditions are cramped in mom’s uterus, as with twins, triplets, etc.

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Flat head fastener

Other babies are born with a type of stiff neck called “torticollis“. This is another Latinate name for a simple concept, that is “twisted neck”. Before medicine got a hold of the condition, folks called it “wryneck”. Sometimes babies are born with tight neck muscles on one side, preventing them from turning their heads easily. This would cause the baby to lay on one side of her head, leading to flattening. Sometimes, it’s the other way around: the stiff neck comes as a result of flat head flattening!

Positional plagiocephaly will not affect your baby’s brain growth or damage her development in any way!

Not all strange baby skull shapes happen this way. Sometimes a baby is born with the bones of her skull already fused, prematurely as it were. This is called craniosynostosis (more dead languages here). It means “fused bones of the skull”, oddly enough. This is a condition that will have to be addressed by specialists in neurosurgery. If you have any concerns at all that this is what is going on with your baby, please ask your pediatrician!

What Started All This?

After years of study, researchers figured out that babies that sleep on their backs are less likely to die of SIDS than babies who sleep on their stomachs or sides. Several countries, including the UK and the US, have now instituted “Back-to-Sleep” campaigns, recommending that people lay their babies on their backs exclusively to sleep. It has been remarkably effective in reducing SIDS rates, and even better at increasing rates of positional plagiocephaly!

How Common is “Flat Head Syndrome”?

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Flat head screw

It’s becoming very common. Some studies suggest that, since 1992 when the American “Back-to-Sleep” campaign began, the rate of flat head may be approaching 50%. That is, half of all babies! Are we going to become a nation of people with weirdly shaped heads? Not so fast!

How to Prevent It

Because this is a fairly new condition, compared to the whole history of the human race, we’ve only very recently begun to figure out ways to prevent flat head from happening, while allowing babies to sleep in the safest position possible: on their backs. It cannot always be prevented, but some experts believe that there are several things parents and caregivers can do to reduce the chances of flat head.

Need a SLEEP COACH?

One simple thing is to change the direction that you place the baby down in the crib every night. One night, place her head facing one end of the crib, the next night facing the other end of the crib. That way, if there is something interesting the baby likes to look at, she will turn her head the opposite direction every night. If there is not already something interesting for her to look at, put something interesting there! You can place a mobile or perch a doll she likes on the side of the crib.

Another good preventive method is “tummy time”, always supervised, 10-15 minutes, 2-3 times per day. Some experts believe that there are other benefits to tummy time, for example it will aid the development of your baby’s neck muscles, etc. I don’t believe this. These are the kinds of developmental milestones that will happen no matter how the baby sleeps. You can’t prevent these phases of development! You really don’t need to add other reasons for tummy time: prevention of flat head is good enough!

Experts also recommend limiting time in car seats and bouncy seats. They also recommend carrying the baby on your body in a front or back carrier. If you’ve got twins, you can do both (check out the Twingaroo!)

How to Treat It

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The Helmet

What if, despite your best efforts, the baby develops flat head and/or wryneck anyway? If the baby has developed stiff neck, or torticollis, she’ll probably benefit most from a qualified physical therapist. I recommend discussing this with your pediatrician.

In the early days of positional plagiocephaly treatment, many babies were placed in molding helmets for up to 23 hours per day, over several months. The thought was that the molding could help the head form a more normal shape while the baby’s skull was growing. What researchers did not know was whether a baby’s head would become normal on its own, without the helmet…

…So They Did a Study

In 2014, researchers in the Netherlands published a study in the British Medical Journal looking at two groups of babies with flat head: one group treated with the helmet, and one group left alone. At the end of the study they found no differences between the groups. That means that the group left alone changed back to normal shape just as well as the group treated with helmets! This was true even for babies with severe flat head (Hat tip to Carey Goldberg). Not all insurances pay for the helmet, so this study could end up saving families a lot of money and inconvenience.

Sometimes the Law of Unintended Consequences gives us results that are neutral: neither good nor bad. In this case, the Back-to-Sleep Campaign has given us lower rates of SIDS, and a condition, flat head, that is not serious and goes away on its own. If you have any questions or concerns about this, consult your pediatrician!