Why does my baby have a flat head?
A baby can have a flat head, either at the back, side or moulding of their head when they have had prolonged contact with external surfaces. It is thought to occur in around 50% of babies. The name for this is called Positional plagiocephaly.
What is it and how is it treated? Some reports estimate that positional plagiocephaly affects around half of all babies under a year old but to varying degrees. As improvement, even without treatment, is common, it is difficult to get a true estimate.
This blog was written by Gaynor Robey, a Children’s Physiotherapist in Gloucester.
What is Positional Plagiocephaly?
Positional plagiocephaly is the name for when a baby can has a flat head, either on the back or side of their head, or moulding of an infant’s skull. This is due to prolonged contact with external surfaces. It often becomes apparent when an infant is two or three months old. Some reports suggest that plagiocephaly affects up to 50% of babies under one year in varying degrees. For some babies, improvement will occur without any treatment.
There are two major types of plagiocephaly:
1. Infants with occipital plagiocephaly have a head shape that looks like a parallelogram. The ear will be forward on the same side as the flattened part of the head.
2. Infants with flattening across the entire back of the head have a kind of plagiocephaly called brachycephaly.
What are the causes of Positional Plagiocephaly?
1. Head turning preference
Some babies have a head turning preference to one side; this maybe baby’s preferred sleep position. In regards to brachycephaly, babies spend a lot of time lying on their backs following the Back to Sleep Campaign. Mattresses are also firmer than they used to be, again since safe sleep research. However, doctors still recommend that babies sleep on their backs as the benefit of reducing SIDS far outweighs any dangers due to positional plagiocephaly. If you would like more advice on safe sleep, you can read our blog here on Safe Sleeping… Top Tips.
2. Tight neck muscles
Lots of things can cause babies to have tight neck muscles, including birth or their position in utero. Tight neck muscles may limit them turning their head fully. If this is the case then baby may need stretches to their neck muscles, which can be taught by a physiotherapist.
3. Lack of tummy time
Although it is recommended that all babies sleep on their backs, tummy time during the day is important where possible. A lack of tummy time for whatever reason can contribute to positional plagiocephaly.
4. Prematurity
In the last few weeks of pregnancy, the skull plates become stronger. This means that babies born too soon have softer skulls, which are more prone to moulding.
What can you do to help if your baby has a flat head?
1. Sleep Position
It is important to always place your baby on their back to sleep. However, you can aternate which end of the cot you place your baby to sleep each night and this will encourage them to face both directions. After your baby has fallen asleep, gently move their head to the non preferred side, to take the weight off the flattened area.
2. Rearrange their bedroom furniture.
Babies are attracted to look at light sources and may try to turn their head towards a window.
3. Use playtime for opportunities
Tummy time is very important. It is a good position for your baby to practise lifting their head, develop strength in their back and neck muscles and take weight through their arms. A small roll under their chest may help them maintain this position. Try a little and often approach. Encourage active head turning away from their preferred side using bright and interesting toys, sounds or people’s faces When awake and lying on their back position their head in the middle using a towel, pillow or blanket (only when awake and supervised).
4. Consider how baby spends their day
Reduce the amount of time your baby spends in one position where there is uneven pressure on their head, e.g. baby bouncer chair, car seat. Place your baby in a variety of positions to play and consider using a sling to carry baby where possible.
5. Swap positions for feeding
If bottle feeding alternate the arm in which you hold your baby and encourage them to look away from their preferred side.
6. Holding and Carrying
Hold your baby facing away from you with their ear resting in the crook of your elbow and your other arm between their legs for support, you can do this to either side. Hold your baby close to your chest with their head turned to their non- preferred side.
7. Options for travel
Try to minimise the use of car seats to when your baby is in the car. Using a sling is a good alternative to a buggy when you are out and about. Check how your baby is lying in their car seat. Consider using a small towel to position your baby’s head in the middle and make sure this does not interfere with the straps. Always follow the manufacturers advice to ensure this does not interfere with the function of the car seat or compromise your baby’s safety. If possible position the car seat so that turning to look out of the window is turning away from their preferred side.
Will a helmet help with my baby’s flat head?
The benefit of specialist helmets remains controversial and is not supported or recommended by the Association of Paediatric Chartered Physiotherapy.
If you have more questions about plagiocephaly, head to Gaynor’s website. Gaynor offers virtual appointments, as well as in person ones at her clinic in Gloucester.
