Detecting Flat Head Syndrome or Plagiocephaly
By Eirian Hallinan
There is a condition that causes a baby’s head to become misshapen or have a flat spot and is known as plagiocephaly. The most common type is positional plagiocephaly and happens when a baby’s head develops a flat spot because of pressure on that area. Babies’ heads are soft when they are born so are vulnerable to this condition.
When babies are born and spend time in a position that puts pressure on one part of their skull, this is when the condition typically develops and is known as positional plagiocephaly.
The condition has increased dramatically since the early 1990s because this is when parents were told that putting babies on their backs to sleep would decrease the risk of Sudden Infant Death Syndrome. This advice has saved thousands of babies’ lives.
Sometimes when movement in the uterus is restricted positional plagiocephaly can develop with the baby’s head but is rarer and is usually because the mother has a multiple pregnancy or it can happen with breech babies who get wedged under their mother’s ribs.
There is a birth defect known as craniosynostosis and is a type of plagiocephaly. It is when the joints between the bones of the baby’s skull close too early. With this condition, surgery is needed to help the brain grow properly.
With vaginal births it is common for babies to have misshapen heads because of the pressure to them when they pass through the birth canal. In most cases their heads naturally correct themselves to a normally rounded shape by six weeks. However, if there is a flat spot on your baby’s head after six weeks of age then it is probably positional plagiocephaly.
Plagiocephaly is most common in babies who are premature, have weak muscle tone, have very large heads or are known as good sleepers.
Torticollis is a condition that can cause plagiocephaly. It is common in premature babies and is when they sleep with their head tipped to one side, while the chin is turned to the other and is caused by a tight or shortened muscle on one side of their neck.
If your baby develops a flat spot on their head
No one’s head is completely symmetrical. In most cases slight flat spots will round themselves by the time the baby is crawling around and sitting up at six months of age but if you do notice your baby’s head beginning to flatten it is advisable that you speak with your doctor straight away.
The younger the baby is the softer the skull is so treatment is best started sooner rather than later. As the baby grows the skull becomes harder and less pliable.
Treatment for positional plagiocephaly
Treatment is decided once your doctor has assessed the baby’s age and the extent of the condition. If the condition is not severe and the baby is young enough then simple re-positional therapy may be administered. In more serious cases then cranial orthotic therapy may be decided and this means using a helmet to change the shape of the baby’s head.
This means regularly varying the position your baby settles and sleeps in. Babies tend to find the same position they find comfortable and you need to alter it to avoid the same pressure being applied to the same part of their head. During the day you can do the following to strengthen your baby’s neck muscles:
- Sleeping – change the direction your baby’s head is facing during naps and bedtime. You can encourage your baby to change direction by himself by swapping ends of the crib to lay him down. If the crib is against a wall he will naturally face the open room rather than the wall so you can hang a mobile on the side you want him to turn to. DO NOT use rolled up linen or towels or positioners to try and keep your baby’s head in place and on one side as this can increase the risk of suffocation or Sudden Infant Death Syndrome.
- Feeding – if you bottle feed, alternate the side you feed him on, as you would if you were breastfeeding. This can help not to constantly apply pressure to the flat spot.
- Sitting – Do not leave your baby in any seat for long periods. For examples; bouncing seat, car seat, baby swing or baby carrier.
- Tummy Time – provides a break for the occipital area (back of their heads) and gives babies a chance to strengthen their neck muscles to prepare them for crawling, pushing up, rolling over, sitting up and eventually standing. It can prevent plagiocephaly because stronger neck muscles help babies to move their heads around while sleeping so it doesn’t always rest in the same position. Babies who aren’t used to being on their tummy from day one may have to be cajoled into it, beginning with a minute or two at a time. Tummy time is also important for motor skill development.
- Physical Therapy – daily exercises which your doctor would talk you through. Gently done, these exercises aim to increase the range of motion in your baby’s neck.
Cranial Orthotic Therapy
If the treatments described in the above points are not working then your doctor may advise this. It involves your baby wearing a helmet or headband (known as a cranial orthotic) which are custom made and worn up to 23 hours per day. Treatment usually lasts between two and six months. The treatment is most successful when begun early which would be six months of age. Some doctors think that it is not very helpful beyond twelve months of age because of the skull bone being too thick by then. The headgear is lightweight and babies get used to wearing them very quickly.