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Babies With Flat Heads

There isn’t a week that goes by that I don’t see a baby with a flat head. The medical term for it is plagiocephaly (we like these fancy terms, it makes us feel smart). The truth is that flat heads are really common ever since we started having infants sleep on their backs (which decreases the risk of SIDS). In an infant, the head is relatively big and the skull isn’t fused (there are floating plates that make up the skull allowing for the head to mold as it is birthed out a small hole). When infants lay flat on their backs, the head molds flat.

There are really two types of flat heads–the ones you’re born with and the ones that develop. Your pediatrician can help you determine which type you are dealing with.

  1. Craniosynostosis: Happens when the small plates of the skull fuse closed too early causing the head to grow misshapen. This can create all sorts of problems for the baby and requires surgical correction.
  2. Positional plagiocephaly: Happens from pressure on one spot of the head causing it to become flat. Of the two types, this is far and away the most common. It happens when kids are “good sleepers” (so their heads are laying flat on the mattress for many hours) or favor the same side when they sleep. Usually the back of the head becomes the most flat. On occasion, the flattening will be to one side of the back which happens when a baby always sleeps with the head to one side. On occasion, the pressure from pushing the head flat will cause the front of the head to be asymmetric (e.g., the forehead or ear will protrude forward).

Prevention of Plagiocephaly

As is usually the case in medicine, prevention is the key.

  1. As much as possible, get babies off of their back (when they’re awake).
  2. Try and get plenty of tummy time.
  3. Don’t let your baby sleep in the car seat (after the car ride). The car seat is really hard and can contribute to flat heads.
  4. Alternate the direction your baby’s head is laying each night (one night, the head turned to the right, the next night the head turned to the left).

How is it diagnosed?

Plagiocephaly is a diagnosis that is made by simply looking at child’s head. Invasive labs and head imaging (xrays, CT scans, and MRIs) are not necessary. The potential exception to that rule may be in the case of craniosynostosis, but your pediatrician should be able to tell positional plagiocephaly from craniosynostosis by just looking. If a child has craniosynostosis (which gives a unique set of head shapes), the neurosurgeon (or craniofacial plastic surgeon) may order head imaging prior to surgery.

How is it treated?

Treatment of plagiocephaly depends on the cause. If it is due to premature fusion of the skull plates (craniosynostosis), then your child will need surgery to open the plates back up. If the cause is from positioning, your pediatrician may recommend repositioning your baby’s head when sleeping. If the cause is from torticollis (tight neck muscles) holding the head in one constant position, your baby will likely be referred to a physical therapist for stretching and range of motion exercises. In some severe cases, your pediatrician may recommend a specially fitted helmet to reshape the head. It is worth mentioning that treatment is most effective when initiated early (while that soft spot on top of the head is still large, so there is plenty of room for reshaping of the head).

Should I worry about it?

The most important thing to remember is that positional plagiocephaly is completely cosmetic. While you may not like how it looks, it will not cause brain damage. It will not affect your baby’s growth or development. As always, if you have questions or concerns, make sure and discuss them with your pediatrician.