Positional plagiocephaly (or flat head syndrome), used to be infrequent and only occur because of certain conditions in the womb. But according to Dr. Christopher Forrest, head of plastic and reconstructive surgery at SickKids Hospital in Toronto, because of “the Back to Sleep movement, in which babies are put to sleep on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS), it’s as common as one in five or one in six babies.”
For parents who notice their newborn baby’s head is flat on one side, “it creates huge anxiety, especially for new parents,” says Dr. Forrest.
Positional plagiocephaly can develop when a baby spends a lot of time lying on their back or prefers to look to one side, says Dr. Clare Hutchinson, a pediatrician at Toronto’s North York General Hospital.
“This is because the bones in an infant’s head are soft and can change shape with pressure,” she says.
“Instead of the head having a round shape, there is a flattened area on one side of the head near the back.” If you’re looking down on your baby’s head from above facing away from you, and imagine it like a clock, you may notice the rest of the head changes shape either at around four to five or seven to eight o’clock. “In particular you can see the forehead protruding on the same side of the head as the flattened part.”
See your child’s doctor to rule out other medical issues. In most cases, the chances of a flat head being indicative of other more serious health issues are rare, says Dr. Forrest, and in these instances, a diagnosis can be made soon after birth.
With normal cases of positional plagiocephaly, the condition spontaneously improves after the baby reaches six months of age, when they spend less time on their back and have developed greater neck strength. However, parents can affect this process.
“The first step is to change your baby’s position often, and to include lots of tummy time in their daily routine – it’s a great way to take pressure off the head and to encourage your baby to develop their head control,” says Dr. Hutchinson.
“You can also encourage your baby to look to their least favourite side using toys during playtime or by switching the direction they are lying in their crib each night, though babies should still be put to sleep on their backs to decrease the risk of SIDS.”
Parents who are still concerned about the shape of their baby’s head have a couple of options. Your doctor may find that your baby’s plagiocephaly is related to torticollis, where one of the muscles in a baby’s neck is tight and prevents them from turning their head fully.
“If this is the case, your doctor may refer you to a physiotherapist for stretching exercises,” says Dr. Hutchinson. “If your baby has severe plagiocephaly, your primary care doctor may also consider referral to a neurosurgeon to be sure the skull bones are formed and growing normally.”
Many parents opt for a molding helmet. “This is now a huge industry,” says Dr. Forrest. “A molding helmet may have some advantage in altering head shape in babies. What we do know is that molding helmets make parents feel better.”
Do molding helmets make a difference? Some research has found no advantage to using a helmet, while other studies show that using a molding helmet as early as four months helps change head shape faster.
Babies wear the helmet for 23.5 hours each day for several months.
It can cost $2,500 and needs to be adjusted and checked every month to make sure there are no concerns about pressure points, skin rashes or skin that has been rubbed uncomfortably by the helmet.
There is no need to see a specialist to have your baby fitted for a helmet. Dr. Forrest says that a referral from your pediatrician can be made directly to an orthotics department at your local children’s hospital.
Though the thought of putting your baby in a helmet can sound overwhelming, Dr. Forrest says that kids do adapt to their helmets. “Families decorate their helmets and it becomes a 'fashion accessory'. Sometimes it’s hard to wean them off!”
Prevention is key. “Tummy time is important,” says Dr. Forrest. “I also advise parents not to panic. It does get better by itself, but we don’t know to what degree.”
He points out that we all have some degree of asymmetry. “In fact, studies show that asymmetrical heads have actually been found to be more attractive.”
Originally published in ParentsCanada magazine, April 2015.