One of the sweetest surprises of welcoming a new baby is just how adorable they are with tiny fingers, squishy cheeks, and that little head you can’t stop kissing. So it can catch parents off guard when that precious head doesn’t look perfectly round at first. The good news? There’s a very normal reason for it.
Your baby’s skull is soft on purpose so they can pass more easily through the birth canal. As a result, it’s not uncommon for babies to arrive in the world with misshapen heads. Usually, any flat spots or high spots even themselves out on their own by about six weeks of age, but a preference for sleeping in one position or another can lead to positional plagiocephaly, also known as flat head syndrome.
The American Academy of Pediatrics recommends that infants sleep on their backs. It’s the safest way for babies to sleep, and the recommendation has resulted in a dramatic decrease in SIDS (Sudden Infant Death Syndrome) but a rise in positional plagiocephaly.
What is plagiocephaly?
Plagiocephaly is an umbrella term describing a range of skull deformations. Most of the time, it refers to flat head syndrome or positional plagiocephaly, a condition in which your baby’s head develops a flat spot or becomes misshapen during early childhood. It’s almost always a cosmetic condition that doesn’t cause brain damage or otherwise impact your baby’s health. It can, however, cause facial deformities if not treated.
When babies first enter the world, they’re still in development mode. Their skull bones are still soft and moldable enough that regular pressure in the same spot while sleeping can cause that part of your baby’s skull to change shape. This form of plagiocephaly occurs in many babies.
Plagiocephaly usually impacts only one side of the head and can make the head appear abnormal or uneven. You or your child’s pediatrician may notice positional plagiocephaly when your baby is around six to eight weeks old. Common symptoms include:
- Flat area of the skull
- Missing hair in one spot
- Misshapen or slanted head shape
- Nose pushed to one side
- Uneven ears
- Forehead, eye, or cheek that appears fuller on one side
Plagiocephaly may also come along with a condition called torticollis, a tightening of the neck muscles that causes the head to twist or rotate to one side. Most of the time, babies grow out of plagiocephaly on their own, but some may need treatment to help things along.
Occipital Plagiocephaly vs Synostotic Plagiocephaly
The two main types of plagiocephaly include occipital plagiocephaly, also known as positional plagiocephaly or flat head syndrome, and craniosynostosis, also known as synostotic plagiocephaly. They differ both in their causes and in the way they present.
Positional plagiocephaly is most common and usually a cosmetic condition, but it can cause problems with eating, chewing, and vision. It can also cause children to become self-conscious if facial deformities are present, impacting their social experience.
Craniosynostosis is less common, impacting roughly one in 2,000 babies. It’s a congenital deformity caused by premature closure of the skull sutures between the skull bones. Skull sutures serve as growth plates, allowing the skull to grow as the brain grows. Sometimes, one or more of those sutures close early, causing uneven growth and an abnormal head shape. Symptoms of craniosynostosis include:
- Missing, full, or bulging soft spot
- Bony ridges along the skull bone sutures
- Facial abnormalities
- Poor feeding or vomiting
- Seizures
While positional plagiocephaly is largely cosmetic and usually resolves with simple, at-home treatments, craniosynostosis can be more serious and may need surgery or helmet therapy to reshape the skull.
A pediatrician can usually tell what type of plagiocephaly a baby has just by looking at the shape of the skull. In positional plagiocephaly, deformation usually occurs at the back of the head and toward one side. This can cause the ear and the forehead to get pushed toward the front on that side. When viewed from above, the skull has a shape similar to a parallelogram.
Craniosynostosis, by contrast, can appear in several ways. The most common forms are sagittal craniosynostosis, which causes a long and narrow head and possible forehead prominence, and bilateral coronal craniosynostosis, which causes a short and wide head. Other types include unilateral coronal craniosynostosis and metopic craniosynostosis, which cause a rotated facial appearance or triangular forehead, respectively.
What causes flat head syndrome?
If your baby gets a flat spot in their skull, it doesn’t mean you’ve done anything wrong, and it isn’t a sign of poor health or neglect. In fact, it’s actually the opposite. Plagiocephaly is often caused by your baby sleeping on their back, which is the safest way for them to sleep.
While flat head syndrome can affect any baby, premature babies are at higher risk because their skull bones are less developed, more malleable, and they spend more of their time lying down. Other risk factors include:
- Multiples (twins, triplets, etc.)
- Assisted delivery with forceps or a vacuum extractor
- First-born children
- Being male
- Less tummy time
- Low activity level
Does mild plagiocephaly correct itself?
Plagiocephaly usually shows up in the first few months of life and typically improves on its own with time. During well-child checks, your pediatrician will check your baby’s head shape at regular intervals to determine if plagiocephaly is present and what treatment is necessary. With these simple, at-home remedies, flat head syndrome usually fixes itself.
How to Avoid Flat Head
The first step in your plagiocephaly plan is prevention. Most cases of flat head syndrome are caused by sleeping in the same position over and over. Changing your baby’s sleeping or lying position helps to balance outside pressure on the skull and prevent flattening in any one spot. Importantly, babies should always sleep on their backs. Never put your baby down to sleep on their side or tummy, and keep cribs clear of any blankets or toys.
Babies look toward light and activity, so they may continue to turn toward a window or door, over and over. Try placing your baby’s head at one end of the crib some nights and the other end on other nights, so they turn in different directions. Avoid having your baby spend too much time in car seats, carriers, bouncers, and strollers while your baby is awake.
If neck muscles are weak or if torticollis is present, your baby may favor one position over others, leading to repeated pressure on the same spot. Tummy time is one of the most effective ways to prevent plagiocephaly. Spending time on their belly helps your baby strengthen neck muscles and other key muscle groups, allowing them to better support their head. If your baby hates tummy time, try putting favored toys just out of reach, start with short periods, or try these other tips and tricks.
The key is to make sure your baby isn’t spending too much time in the same position. Change sleeping position often, hold your baby often, cradle and support your baby’s head in different positions throughout the day, switch arms, and let your baby lie on you, chest-to-chest.
Treatment Options for Plagiocephaly
For mild cases of plagiocephaly, at-home treatments involve exercises and behavioral changes similar to those listed above for avoiding flat head. Tummy time is an important part of every baby’s development, helping them strengthen core muscle groups like the neck, arms, and back. Spending time off their back also helps prevent plagiocephaly.
Some babies may need physical therapy or home exercise programs, especially if torticollis is present. A physical therapist can teach you exercises and stretches that are safe and effective for your baby, to help strengthen neck muscles and relieve symptoms. These strategies are most effective before four months of age, when your baby’s skull is still soft and malleable.
If symptoms are severe, your pediatrician may recommend a plagiocephaly helmet (cranial remolding orthosis) or band therapy. These devices are custom-designed for your child and may be worn between two and six months, on average.
A specialist will measure your baby for a cranial helmet or bands. Often, they are tight where the skull is round and loose where the skull is flat, encouraging the skull to grow into a more typical shape over the course of several months, with adjustments made every couple of weeks.
What to Expect with Early Intervention
Early intervention begins at your baby’s regularly scheduled wellness visits. Your pediatrician will check your baby’s head shape and carry out a visual examination. Usually, a doctor can quickly determine whether plagiocephaly is present and whether it’s positional or synostotic.
In most cases, early intervention involves repositioning during sleep and monitoring how your baby’s head shape changes. If your baby favors one side or the other, gently turn them the other way while they sleep, and hold them as much as possible. Not only is this a great way to bond with your newborn, but it also lowers the amount of time they spend lying on their back. With gentle redirection and tummy time, your baby’s head will often round out naturally as they grow, move more, and spend less time resting on one spot.
Sources:
American Association of Neurological Surgeons
American Academy of Family Physicians
