Medically Reviewed by Dr. Navin Ramchandani, Medical Doctor/ Diagnostician and Owner of R&R Medical Centre in Barbados.
You know it when you see it. A baby with a slightly off kilter look. Maybe their ears are lopsided, their eyes don’t quite match up, or you can see a bald spot on the back or side of their head. This bald spot can develop into a flat and misshapen area, but it is not a sign of something seriously wrong.
If treated, flat head syndrome, can be a temporary deformity that does not affect normal development or have a negative impact on brain functioning. It is, however, a condition that warrants some input from your medical professional about how best to treat it.
Flat Head Syndrome, or its medical name, plagiocephaly, is a condition where infants develop a flat spot on the back or side of their heads causing a misshapen look. Flat head syndrome is a common malady that affects up to half of all babies.
The syndrome’s most common cause can be simply too much time in one position, while the baby’s head is still soft and forming. This can happen while in utero or after delivery, but most commonly develops during the first six weeks after birth. Another possible cause is genetics and flat head syndrome can be a form of congenital anomaly that may need surgery.
“Flat Head Syndrome in babies can be caused by either spending too much time in one position while the baby’s head is soft and forming, or genetic,” explains Dr. Ramchandani. “It’s important to diagnose the cause so your physician can determine the best course of treatment.”
Let’s break this condition down so you can understand the basics of each type of flat head syndrome and learn what can be done to correct the problem.
“There are two types of flat head syndrome known as positional plagiocephaly and cogenital plagiocephaly,” says Dr. Ramchandani. “The causes differ in both; positional is caused by the environment and cogenital is caused by genetics.”
The two types of flat head syndrome are referred to in medical terminology as positional or deformational plagiocephaly if it is caused by the environment, or congenital plagiocephaly or craniosynostosis, if caused by genetics.
You will notice that both are types of plagiocephaly which comes from the Greek words plagio, “to slant,” and cephalic meaning “head,” or quite simply, slanting head. This flat or slanting head syndrome has two distinctly different causes and treatments, but neither is life threatening.
Positional plagiocephaly or flat head syndrome is usually the direct result of too much time spent in one position. Babies have a skull that is unfused and still moveable when there are very little.
This allows for the rapid brain growth that takes place after birth. We all know how, for a period of time, most babies seem like they have heads too big for their bodies, this is due to the massive early development of the brain and the skull’s ability to expand as needed. As the child grows older, the skull will fuse and stay in place to protect the brain.
This movable skull, however, in the early days, allows for the shape of the head to change given different variables. If your child spends too much time lying on their back (the recommended sleep position to prevent sudden infant death syndrome or SIDS) that part of the head may flatten and appear misshapen.
This holds true for too much time in any one position; sleeping on their side in a car seat or swing, lying on the same side while nursing, or lying on their back during the day in addition to sleep. It usually takes about six to eight weeks before the condition is noticeable.
Read More: Safe Sleeping Tips for Newborns
There are other factors that can cause or contribute to flat head syndrome. If your child is a twin or multiple, and uterine space was limited (which of course it was), your child may have been pressured into a position that caused their skull to develop flat or slanted areas.
Being squished into a tight position can also cause the neck muscles to tighten making it difficult for the baby to move their head, even after birth. The result can be a child who may naturally lie in a position similar to that of the womb, and this can exacerbate the already existing flat spots causing skull deformity.
There are also the neck muscles to consider. When the neck muscles are inhibiting movement, the condition is called torticollis and comes from the Latin meaning “twisted neck.”
This can be a secondary condition of flat head syndrome as once the head is flat in a certain area; babies tend to favor sleeping or lying on that area, and this can then shorten the neck muscles and cause torticollis.
Premature babies also can be at greater risk for flat head syndrome. Their skulls are softer than regular newborns during their first months of life, and they can be especially susceptible to flat spots if they spend a lot of time sleeping or lying in one particular position.
For flat head syndrome that is by the baby’s relationship to sleep position there are three basic fixes. They work well, and you can rest assured that they will correct the problem.
“Positional balance and exercise are possible treatments for positional plagiocephaly,” says Dr. Ramchandani. “Consult with your doctor to find the best course of action based on the severity of the condition.”
Which one you choose depends on the severity of the condition, and this is an area to follow your doctor’s advice. You can work on positional balance, doing exercises, or using a helmet to mold the head.
If spending too much time in one position is causing the problem, then it makes sense that balancing out time in different positions can help. And, in fact, in many cases if you just encourage your baby to spend time on their stomach, called “tummy time,” as well as helping them balance out their activities in different positions, it will correct the problem.
Switch positions when feeding, place a support pillow designed for flat head syndrome in the car seat or swing, or even in the crib. Massage your baby’s head and try to monitor the amount of time they spend in the position that is causing the flat spot.
Related: Best crib mattress
Exercises might be what your doctor recommends, especially if torticollis is causing the problem. Stretching the neck can help to balance out the muscles and support your baby in better movement and options for head position. You may get referred to a physical therapist who can oversee this exercise routine, but because the exercises are done to your baby and not by them, it is important that they be done properly.
Using a helmet, something prescribed by a doctor and fitted by a professional, is an effective way to round out your baby’s head and there are many success stories. The therapy is sometimes considered controversial and does not work for everyone, but many doctors will encourage it as a reliable fix.
A cushioned helmet is fitted for your little one, and they need to wear it, both day and night, from a few months to half a year to see results. There are lots of variables like how old the child is when they start wearing a helmet and how severe the problem is.
Congenital plagiocephaly is considered a form of birth defect which happens in about 1 in 2,000 or more babies. The coronal sutures, which are connective tissues in the skull that run from the top of the head to either side of the ear, can close too soon and cause the skull to solidify. When this happens, the brain may not have room to grow normally.
This condition, which is clinically referred to as craniosynostosis, can be serious and cause permanent deformities, seizures, and developmental delays as the brain’s growth is restricted. It can also be part of other illnesses that affects greater parts of the body.
For congenital plagiocephaly, surgery is often the treatment of choice. If your child is under a year, doctors can perform a procedure to open those closed coronal sutures, allowing the brain to have room to grow normally and to correct cosmetic concerns. There are two types of surgery performed for this condition. First an endoscopic version that is less invasive and performed on babies less than six months old. This can be just a one-day hospital stay and a small incision.
The second option is open surgery, performed on babies older than six months. It requires three or four days in the hospital and is far more invasive. The skull is cut open and reshaped, then held in place with absorbable screws. In severe cases, more than one surgery may be needed, but results from these procedures are generally very successful.
As described above, helmet therapy can help reshape the head. It may be used after surgery to help mold for proper symmetry.
The most important things to know about flat head syndrome are that it is common, and it is fixable. Even severe cases, or ones caused by a congenital condition, can be mitigated.
The most common cause is too much time in one position, which can be fixed by creating balance in your baby’s day, doing more tummy time, wearing a helmet, or doing exercises.
Surgery can be an intervention if the problem is related to genetic causes that leave the brain fused too early. In any case, flat head syndrome is curable, so see your doctor and be optimistic.
Dr. Navin Ramchandani is a Medical Doctor/ Diagnostician and Owner of R&R Medical Centre in Barbados. He is also an Advanced Paediatric Life Support (APLS) International instructor with the Advanced Life Support Group (ALSG), and a Paediatric BASIC (Basic Assessment and Support in Intensive Care) international instructor. His passion is diagnosing and treating/helping people with complicated health issues to improve their overall health and quality of life.
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