Flat head syndrome

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Have you noticed that one side of your baby’s head appears to be a little flatter than the other? Your little one may have what’s called flat head syndrome, a condition that usually resolves with time and some corrective measures. Flat head syndrome can be associated with stiff neck muscles and changes in the appearance of your baby’s head, so it's important to take preventive measures and get prompt treatment if needed. Read on to learn more about flat head syndrome, why it happens, and how to fix it.

What Is Flat Head Syndrome?

The plate-like bones that make up your baby’s skull are soft and malleable so that they can make room for your baby’s rapidly growing brain. When your baby spends a lot of time lying with his head turned to one side, the weight of his head can cause a patch at the back or side of the skull to flatten.

This condition is called flat head syndrome or positional plagiocephaly.

In time, and with corrective measures, the flat patch will round out. Having flat head syndrome in babyhood won’t affect your little one’s brain growth.

Keep in mind, though, that the stiff neck that’s sometimes associated with flat head syndrome can affect early development. This is you'll want to follow through with any repositioning techniques, physical therapy, or at-home exercises recommended by your child’s healthcare provider.

Signs and Symptoms of Flat Head Syndrome

Here are some of the signs that your baby has flat head syndrome:

  • One side of the back of your baby's head looks flatter

  • A bald patch may appear on the flat area because that area rubs against surfaces more often than the other side

  • The ear on the side that has flattened may be bent forward

  • If your little one has a severe case, the forehead may bulge out on the opposite side

  • Your baby’s neck, jaw, and face may look uneven if the flat head syndrome is caused by a stiff neck muscle.

Causes and Risk Factors

Sleep position is a chief contributor to flat head syndrome — and babies spend a lot of time sleeping — but keep in mind that all babies need to be placed on their back to sleep to reduce the risk of sudden infant death syndrome (SIDS). Back sleeping is the safest position, even if your little one has flat head syndrome.

The following can also be contributing factors:

  • Sitting in a car seat for extended periods

  • Being in a baby carrier or stroller for long stretches of time

  • Spending extended periods in a baby swing or baby bouncer.

About 20 percent of babies with flat head syndrome also have torticollis — a condition in which a baby’s neck muscles are stiff and the baby has trouble turning his head to one side.

Favoring one direction can lead to a flat patch forming on the preferred side, as it has prolonged contact with a surface. Having a flat spot can then make the torticollis worse, as your baby may be even more inclined to leave his head in that position, making the neck even tighter and more contracted.

Preemies are more likely to have flat head syndrome because their skulls are typically softer than that of full-term babies. And premature babies may also be spending more time lying on their backs getting medical care in the neonatal intensive care unit (NICU).

Not all instances of flat head syndrome relate to your baby’s position after birth. A flat patch may start to form in the womb, for example if your baby is in a position where the skull is pressed against your pelvis, or in the case of twins or multiples if the head is pressed against the other baby.

A flat patch can also form due to pressure on the skull in the birth canal during a vaginal birth, or if forceps or a vacuum extraction was used during delivery.

How to Prevent or Treat a Flattened Head in Your Baby

Given your baby must always be placed on her back to sleep to help prevent SIDS (even if she has flat head syndrome), these are some of the things you can do when your baby is awake to help correct or prevent a flattened head:

  • Limit time spend in swings, car seats, and bouncy chairs so that your baby has as much time as possible to move her head freely and relieve pressure on the flatter area of the head.

  • Give your baby lots of supervised tummy time when she is awake. Tummy time helps strengthen your baby’s back and neck muscles; encourages the rounded shaping of the back of her head; and has many other developmental benefits, including giving your baby a different view of the world and helping her learn to push herself up on her arms.

  • Hold your baby whenever possible during the day instead of placing her in a swing or stroller, for example. Holding your baby takes the pressure off the flat area and helps the head return to its normal rounded shape. Using a baby wrap or a front carrier to carry your baby may be a good way to allow your baby to move her head while keeping your hands free.

  • Switch up how you place your baby in the crib. For example, place her so that she’s on her back but facing the wall so that she has move her head and neck in the other direction to face out toward the room.

  • When your baby is asleep gently move her head so that the flattened side is up. Do not use pillows or blankets to prop your baby’s head in this position though, as any object placed in your baby’s crib can increase the risk of strangulation or choking.

  • Give your baby something interesting to look at on the non-preferred side. Place a mobile in the opposition direction to the side she favors, or move your baby’s crib to encourage her to want to turn her head to explore the new things out of her line of vision.

  • Alternate the arm you use to hold your baby during feeds. This will encourage your baby to turn her head both ways equally.

  • Change your baby’s diaper from the opposite side. This may take a bit of getting used to, but by placing her in the opposite direction on the changing table, or standing to the opposite side that your baby favors, you encourage her to try to face you: Your little one will always want to look in your direction, especially if you’re talking to your little one or making funny sounds and faces!

  • Follow your provider’s treatment plan. To treat flat head syndrome and to stretch your baby’s neck muscles if he has torticollis, your child’s provider may recommend physical therapy and exercises to do at home. Your child’s provider will be able to show you how to do these correctly and will tell you how often to do them.

  • Helmet therapy. Your child’s healthcare provider may prescribe the use of a special custom-fit, molded helmet to treat a more severe case of flat head syndrome. The special helmet is designed to encourage the head to grow where it is flat, and it works best until age 1 when the bones of the skull are still malleable and the brain is growing rapidly.

Diagnosis

Your baby’s healthcare provider will be able to diagnose flat head syndrome by looking at the shape of your baby’s head. If torticollis is also suspected, your baby’s provider will look at the way your baby moves her head and neck to make a diagnosis.

If you suspect your baby has either flat head syndrome or torticollis, it’s best to schedule a checkup so your child’s healthcare provider can examine her.

Taking the Long View

As your baby grows and develops, he will begin moving around, spending time sitting, crawling, and walking, and will naturally be looking in all different directions. He will also be able to change sleep positions by himself. All of this activity and movement will take pressure off the flattened area of the head. With professional treatment and/or the kinds of at-home steps listed above, the flattened area will improve (even if your baby had a severe case of flat head syndrome) over a period of months or years. Thicker hair growth will also mask the flat spot so that it’s less noticeable. Remember, your child’s healthcare provider will keep a close eye on your baby’s skull shape, neck movement, and overall development at each well-child visit. Your little one’s development is in good hands, and the shape of your baby’s skull will round out soon enough.

FREQUENTLY ASKED QUESTIONS

  • The head shape will likely correct itself in time, especially if simple measures are taken to relieve pressure on the flattened area of the skull. In some cases, though, physical therapy, special exercises, or a helmet may be needed to help treat flat head syndrome.

  • Flat head syndrome is not usually a cause for worry — it doesn’t cause brain damage or affect brain development. Think of it as more of a cosmetic issue, which should right itself as your baby gains more head and neck control and starts to spend less time with his head resting on a flat surface.

    Nevertheless, there are steps you can take to reduce the amount of time your baby spends lying on his back, such as by introducing more tummy time and by limiting time spent in a car seat, stroller, bouncer, or swing. All this will help resolve the flat head syndrome.

  • Flat head syndrome is quite common and usually not dangerous or permanent; however, you should always follow your healthcare provider’s treatment advice, whether it’s regularly changing your baby’s position, doing physical therapy, or using a special helmet.

  • You may start to see improvements within a few months if you take steps to reduce the amount of time your baby spends lying with his head resting on the flattened side. For example:

    • Give your baby lots of tummy time
    • Limit time spent in a stroller or car seat
    • When your baby is in his crib, gently turn his head in the other direction so that the flat part of the head doesn’t touch the mattress and has less pressure on it.

The Big Picture

Experts say that the best treatment for flat head syndrome is to prevent it in the first place by ensuring your baby doesn’t spend too much time in a lying position when she’s not sleeping. Give your baby supervised tummy time; hold your baby instead of placing her in a bouncer or stroller; and take steps to ensure she’s facing different directions when she’s in the crib by gently directing her head to the opposite side to the one she favors. Enticing your baby to look the opposite way by dangling toys or making funny noises and faces can also help. If your little one has flat head syndrome, follow your healthcare provider’s treatment plan, whether it’s continuing with the repositioning techniques we’ve described above, physical therapy, special at-home exercises, or a helmet that helps treat the flat head. With a little time, the flat patch on your baby’s head will round out, and your little one’s head shape will be back to normal.

How We Wrote This Article
The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.