Why does my baby have a flat head?
- Baby Steps Physiotherapy
- Feb 2, 2024
- 4 min read
Understanding #Plagiocephaly
In recent years, there has been a growing awareness of plagiocephaly, a common condition that affects the shape of a baby's head. Plagiocephaly, also known as flat head syndrome, occurs when there is a flattening or asymmetry in the shape of a baby’s skull.
The skull is made up of 5 unfused plates. This allows the skull to change shape and get smaller to pass through the birth canal, and to get bigger to allow for rapid brain growth.
While plagiocephaly is concerning for parents, it is important to know that in most cases it is cosmetic and does not affect brain growth.
That being said, there is a strong link between plagiocephaly and torticollis (preferential head turn), and more recent evidence demonstrates a significant link between plagiocephaly as a risk factor for developmental delay. This highlights the importance of getting your baby checked by an appropriately trained medical professional if you have any concerns.
Below we will explore the most common causes, prevention methods and treatment options.
Causes:
1. Positioning: This is the most common cause of plagiocephaly. Positioning of the baby in utero and/or post-natally, can influence the shape of a baby’s skull. We know that prolonged time in one position can lead to flat spots, therefore sleep position plays an important role in causation. Since the introduction of the ‘Back to Sleep’ campaign, we have seen an increase in positional plagiocephaly. Mattresses are also firmer which further contributes to flat spots. Plagiocephaly caused by sleep position generally results in a flattened area across the back of the skull. Increased time spent in ‘containers’ such as car seats, bouncer chairs, buggies and prams can also cause plagiocephaly.
2. Muscle Imbalance: Torticollis, or preferential head turn, a condition where the neck muscles are tight or shortened on one side, can contribute to plagiocephaly. Infants with torticollis may prefer to turn their head to one side, or only be able to turn their head one way, leading to uneven pressure on the skull and therefore flattening. Plagiocephaly caused by a head turning preference generally results in a flattening over one side of the skull (i.e. if they prefer to turn right, the flat spot will be on the right side of the skull where it is being pressured).
3. Multiple Births: Twins or multiples are at a higher risk of developing plagiocephaly due to limited space in the womb. Baby’s head may develop a flat spot in utero due to resting position. This may also be linked with torticollis and talipes (positional foot deformity).
Treatment Options:
1. Baby Physio: This is the recommended treatment for both plagiocephaly and torticollis. Exercises and stretches can be prescribed to address muscle imbalances. Physio exercises will also help to develop head control, muscle strength and motor development. A specialist baby or paediatric physio will give advice on positional changes, handling techniques, and developmental play to manage plagiocephaly.
2. Helmet Therapy: In rare cases, where the head shape does not improve with repositioning and physiotherapy, cranial helmets may be used. Helmets aim to allow growth in specific areas of the skull to aid symmetry. These are NOT recommended by the NHS due to lack of robust evidence.
3. Education: Raising awareness about plagiocephaly, it’s causes, and the recommended treatment is crucial. This means that parents can implement preventative steps in the management of this condition, hopefully decreasing the incidence.
4 Easy Ways to Prevent Plagiocephaly:
1) Tummy Time: Placing baby on their tummy little and often throughout the day will not only help strengthen neck and shoulder muscles and develop head control but will also reduce the likelihood of developing plagiocephaly. Remember, tummy time can also be on you via chest to chest or reclined sitting.
2) Change Sleeping Positions: Turn baby’s head when they are sleeping to help distribute pressure evenly on the skull. You can also turn baby up the other way in the cot so that they have to turn their head the opposite way to see you. Remember, always place your baby on their back to sleep.
3) Decrease ‘Container’ Use: Limiting the time infants spend in car seats, swings, prams, buggies, bouncers, pods, seats etc can help to prevent plagiocephaly.
4) Use a Sling or Carrier: Slings and carriers have so many benefits; skin to skin, attachment, bonding, hands-free time for parents, but they are also shown to help prevent plagiocephaly due to decreased pressure on the back of the skull.
In summary, even though plagiocephaly is common, it is vital to start intervention as soon as possible to prevent secondary effects such as torticollis or subsequent developmental delay. Early intervention is key for the best outcomes.
If you are a new parent or have a new arrival, antenatal education and implementing preventative strategies can significantly reduce the risk of a plagiocephaly. Share this with a friend to spread the word!
Have a look at our Instagram @_babyphysio for more tips.
If you have any questions, please do not hesitate to contact me.
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