Flat Head Syndrome

Ever since the American Academy of Pediatrics (AAP) made the recommendation of babies sleeping on their backs, flat head syndrome has been on the rise.  Flat head syndrome is the condition in which the back of a baby’s head is flat, slanted or otherwise asymmetrical, usually based on positioning in the womb or in the first four months of life.  Even with the increase incidence of this cosmetic issue, the AAP still believes that back sleeping is best for babies and lowers the risk of SIDs significantly.

Flat Head SyndromeFlat head syndrome is medically known as plagiocephaly and sometimes called positional molding.  It often occurs in utero where living quarters are pretty tight.  If the baby is positioned in a certain way, he can be born with plagiocephaly.  However, flat head syndrome most commonly occurs with babies who spend too much time lying on their backs, causing their heads to flatten.  Many babies have a preferred position, often with their head cocked to one side or the other, and work hard to get themselves comfortably in their “sweet spot.”  The repetitive pressure in a single position can cause flat head syndrome.  This usually occurs between two and four months when the skull is beginning to thicken and mold into a more permanent shape.

There are no medical concerns linked to plagiocephaly; it is a purely cosmetic condition.  It is typically unnoticeable by the time children reach the age of four, when their heads are bigger and hair covers the flattened area.  But still, it is undesirable and can be avoided with some care.

Although the recommendation remains that babies should sleep on their backs, they should spend plenty of time in other positions while awake.  Tummy time should begin as soon as a baby comes home from the hospital.  This allows baby to strengthen his core, neck and back muscles while also giving the back of the head a break.  Once a baby can roll from his back to his stomach and back again, he will probably start practicing this skill on his own in his crib, giving him even more time off of his back.  Once a baby can roll, it is OK for him to sleep on their stomachs if they turn themselves.  But still place your baby on his back for sleeping.

Baby-wearing is another terrific time to alleviate some pressure from the back of a baby’s head.  Placing your baby in a slightly cushioned sling or front-wearing baby carrier is a wonderful way to spend close bonding time with your baby and allow her head the freedom from lying down.  This upright position will help strengthen her neck and encourage her to start turning her head.  It’s also good for digestion as gravity helps the flow of milk through the digestive tract.

Breastfeeding and skin-to-skin contact are other great opportunities to change your baby’s position to help avoid awkward molding.  When you vary your breastfeeding positions, you will also keep your baby’s head turned in various directions with different pressure points.  And skin-to-skin rocking or lying baby on your chest, which is great for moms and dads, keeps baby off the back of his head.

It’s estimated that 20 to 25% of babies have plagiocephaly.  Some parents choose to correct the problem by having their babies wear a helmet for most waking hours.  This usually corrects flatness over the course of several months.  If you are concerned about your baby’s head shape, ask your pediatrician.  What looks flat to you may be something your pediatrician is sure your baby will grow out of over time.