Managing Positional Plagiocephaly (Flat Head)

Since pediatricians recommended that babies sleep on their backs more than 20 years ago, the incidences of Sudden Infant Death Syndrome (SIDS) have dramatically decreased. However, many children — nearly half of infants 7 to 12 weeks old — experience positional plagiocephaly. This is more commonly known as flattened head syndrome. Due to the softer nature of babies’ skulls, the back or side of their heads can flatten when they always sleep in the same position, causing the skull to lose its rounded shape.

Babies who spend a lot of time on their backs (in cribs, swings, bassinets, strollers or car seats) are more susceptible to developing a flattened shaped head. Often there is a bald spot as well. In most cases, children with positional plagiocephaly also have another condition called torticollis, where tight neck muscles limit their ability to move their necks and cause them to favor one side of the head.

Tips for minimizing positional plagiocephaly

Your child’s pediatrician can diagnose positional plagiocephaly and torticollis without X-rays or other tests. While these flat spots do not pose any health risk, many find them unattractive. There are things you can do to help re-shape or minimize the condition.

• Encourage tummy time. Babies need to learn how to use their neck muscles, and spending time on their bellies during the day is a great way for them to gain strength and learn how to move their heads from side to side. Instead of leaving your baby in a car seat or bouncy seat, give her some time on a play mat on her belly. Leave some toys within reach so she can exercise her arms as well. These skills lead to pushing up and crawling. Make sure you stay with your baby during her tummy time.
• Change positions. During nap and sleep times, re-position your baby’s head to the side that isn’t flattened.
• Exercise the neck muscles. Babies with torticollis usually require physical therapy to strengthen the weak side of their necks. A physical therapist can teach you several exercises and stretches you can do with your baby to help elongate the neck.
• Ask your doctor about special devices. Babies with more severe forms of positional plagiocephaly may require a custom molded helmet. Do not purchase any helmet devices on your own. Only a doctor can prescribe these helmets, and they are used in a small number of cases.

As your baby grows, he will develop more muscle strength to change his own head position and will naturally change positions in the night. The American Academy of Pediatrics recommends putting your baby to sleep on her back. If she is strong enough to roll over and sleep on her belly, it is OK to allow her to sleep that way if it is more comfortable for her.

Once your baby can sit independently, the flattening will not worsen. As your child grows, you will notice that the flattening seems to improve. The head may never be symmetrical, but your child’s face will become more noticeable, his hair will grow and he will become more active. By school age, the flattening is usually no longer a cosmetic issue.

Contributed by: Patrick S. Pasquariello, MD