Head Flattening Prevention 101
Written By: Dr. Alli Chisholm, PT, DPT
I hear it all the time: “Does my baby have a flat head?” or “I’m so nervous that my baby will get a flat head”. Yes, it’s true: baby’s skulls are a lot more malleable in those first few months of life, making them susceptible to obtaining those feared “flat heads”. Read on to find out how you can prevent this from occurring in your little one!
Having access to so much information right at the tip of your fingers these days is wonderful, but also terrifying, especially when you’re seeing things all over the Internet and social media about everything and anything you “should” be doing as a new parent and what you “should” be looking out for when it comes to your new baby.
As a professional in this space AND a mom of two under two (I can still say this for another two weeks at least!), I have some very helpful information to share with you: yes, there are recommendation positions, activities, and a whole dang way of life that is preferred for your newborn, or even your older kiddo.
BUT you are also a new parent trying to figure out how to just survive this new stage of your life, whether this is your first, your second, etc. Because of this, it’s important to prioritize what you “worry” about.
In this post, I break down and simplify how you can prevent one of the common concerns a lot of new parents have these days: preventing head flatness in their little one. But first, let’s check out some different terms you may come across that are all different ways of describing flat head syndrome and why your baby’s head shape may be something you want to put on the high priority list.
Plagiocephaly: head flattening on the back of one side of the head or the other. This is most likely caused by a head preference (ie baby preferring to look to one side over the other), causing prolonged pressure on the back of that particular side of the head. This can also be caused by malpositioning in the womb, or within baby’s environment once they’re born (ie increased use of containers, like a bouncer or a swing).
Brachycephaly: head flattening around the midline portion of the back of the head, which can be caused by increased time of baby on their backs or in a container that maintains the head in the midline position with decreased ability for baby to move their head independently from side to side, as in a bouncer or car seat.
Scaphocephaly (AKA dolichocephaly): sometimes referred to as a “toaster” shaped head, this head shape is common in premature babies, or in babies whose sagittal cranial suture fuses prematurely, which limits brain growth; this is more rare than the other types of head flattening and requires surgical intervention to repair.
What’s the big deal? Why is head flattening an issue?
Brain development: Head flatness has been shown to be linked to delays in development, especially when looking at motor function specifically (1). While more research still needs to be done on long-term effects of positional or deformational plagiocephaly, preliminary research shows that school-age children who have a history of unresolved head flattening may need increased academic support due to the impact their head flattening may have caused on the development of the brain, namely the cerebrum (2).
Custom equipment: While this may be something you’re not thinking of as a new parent, untreated head flattening could require the use of customized equipment, such as a sports helmet, glasses, or any other headwear, since most headwear that can just be bought at your local Dick’s Sporting Goods is made for symmetrical vs asymmetrical shaped heads.
Cosmetic and psychological well being: From a cosmetic standpoint, yes, hair can definitely cover up some imperfections you may not want others to see. For children with head flattening, though, this may be harder to do depending on the severity of the head flattening; or, as an adult, if you happen to go the bald route, it could lead to anxiety related to your appearance and decreased confidence when it comes to your looks.
Facial asymmetry: Coinciding with the last point, head flattening pushes the rest of the facial features forward on that same side, leading to facial asymmetries; this can include asymmetries internally and externally around the ear, the eyes, and the jaw. Based on the anatomy of the head and face, this could impact vision, feeding, and balance.
Now, let’s see how you can prevent head flattening in your little one:
Caregiver habit changes: Make sure that you are interacting with your little one on both sides of their body during diaper changes, feeding, bath times, and when being held (ie switch the side you’re putting your little one’s head on when he/she is on their diaper changing table or in the bathtub if you notice that you are always placing him/her with their head in one direction). This will ensure that pressure is being placed on the back and sides of the head on both sides vs solely one side due to a caregiver’s hand/side dominance.
Firm, flat surface: A firm, flat surface places even pressure on the head when baby is turning their head side to side, allowing for optimal head shaping to occur; a squishy surface tends to make it harder for kiddos to move their heads in both directions, resulting in prolonged pressure on one side of the head and, in turn, resulting in head flatness (ie decrease container use and take away use of positioning pillows).
Side lying play: Yes, tummy time is important, and it is just as important to practice side lying on both sides to strengthen the muscles of the trunk and neck needed for your little one to easily turn their head in both directions, as well as unweighting the back of the head when lying on their back. Help your baby get into a side lying position with their shoulders and their hips stacked on top of one another, roll up a receiving blanket to wedge behind their back to help prevent them from falling backward in this position, and bring a motivating toy, object, mirror, or your face to their belly level to help them tuck their chin, which activates baby’s belly muscles, helping them stay in this position on their own.
Positions where the head is unweighted: As mentioned previously, babies’ heads are very malleable in those first few months of life, due to the cranial bones not being fused together yet. During those first few months, repositioning can help with obtaining and/or maintaining that sought after round head. When the head is unweighted completely, it gives the skull that space to grow out into any flattened areas. These positions include time spent on your baby’s tummy, or sitting upright while being held up in a seated position on a caregiver’s lap at 4-6 weeks of age or older, which is when babies start to gain a little bit more head control.
Limit container use! We’ve also heard this one a lot, but it’s true: positional plagiocephaly is caused very frequently by using those fun containers that everyone wants to get you at your baby shower, like bouncers and swings. While I don’t mind these devices for 15-20 minutes at a time while also making sure you’re switching up which side your baby is looking towards while in the container, relying heavily on these devices causes prolonged pressure on one side of the head due to the difficulty of your baby being able to turn their head from one side to the other. If you can get away with holding your baby in a baby carrier while baby wearing, this is not only a great bonding option with your baby while you’re getting some necessary to-do-list items checked off, but it also unweights the head enough to prevent head flattening.
The good news is, you can also use these activities and recommendations for your kiddo even if you already are noticing some head flatness!
If you DO notice that your child is experiencing head flattening, though, research shows that the earlier conservative physical therapy treatment is initiated (ideally between 0 and 3 months of age), 1) the shorter treatment tends to be and 2) the more likely a helmet can be avoided. Depending on the severity of the flattening, conservative treatment can still make a huge difference even between 3 and 5 months of age; after this time period, if the head flattening is severe, typically a consultation for a helmet is recommended.
If head flattening is something you’re concerned about for your little one, make sure to reach out to The Moving Peanut to schedule an evaluation for your little one ASAP if you’re local to Seacoast NH, or feel free to send us a message if you need help finding a physical therapist near you!
Resources
Speltz ML, Collett BR, Stott-Miller M, et al. Case-control study of neurodevelopment in deformational plagiocephaly. Pediatrics. 2010;125(3):e537-e542. doi:10.1542/peds.2009-0052
Robert I. Miller, Sterling K. Clarren; Long-Term Developmental Outcomes in Patients With Deformational Plagiocephaly. Pediatrics February 2000; 105 (2): e26. 10.1542/peds.105.2.e26
