Newborns: Flattened Head Syndrome

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KEY POINTS

• If your baby has a flat spot on her head that doesn’t go away a few weeks after birth, she may have a condition called flattened head syndrome, or positional plagiocephaly.
• Your baby’s treatment may include head positioning, exercises and stretching, or wearing a helmet to change the shape of your baby’s head.
• You can help prevent flattening by changing your baby's head position from time to time, especially when she is very young.

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What is flattened head syndrome?

If your baby has a flat spot on her head that doesn’t go away a few weeks after birth, she may have a condition called flattened head syndrome, or positional plagiocephaly. If it’s not properly treated, the abnormal head shape can last a lifetime.

What is the cause?

Babies have very little room inside the uterus towards the end of pregnancy and may get stuck in one position. Twins or babies who are in a breech position (bottom down) have less room to move around and cannot change position.

Some babies have tight or shortened neck muscles (torticollis) when they are born. This causes the baby to lie on one side and can result in a flat spot on one side of the head.

Some babies lie in one position most of the time after they are born. A newborn's head is soft and easily molded into a flat shape. If your baby lies on her back with her head in one position for a long time, day after day, her head can get flat on the back or on one side. This can cause a forehead and face that look crooked.

What are the symptoms?

You can start to see flattening as early as 6 weeks of age. You may notice changes in your baby’s face within the first 3 to 6 months.

How is it diagnosed?

Your healthcare provider will review your child’s symptoms and medical history and examine your child. Many babies have some flattening, and usually they do not need medical treatment for it.

How is it treated?

Your healthcare provider will tell you how to change your baby’s head position, and how often to do this. Often, this is the only treatment your child will need.

In some cases, your baby may need special stretching exercises or positioning if her neck muscles are tight or shortened or have been very cramped in the uterus.

If the flattening is affecting your baby’s face, causing one ear to be further forward than the other ear, or if your baby also has a twisted neck that causes the baby’s head to turn to one side, your child may need a helmet that can help reshape your child's head.

How can I help my child?

You can help prevent flattening by changing your baby's head position from time to time. This is especially important when your baby is very young and cannot move around a lot.

Here is what you can do to keep your baby from lying in one position too long:

• Sleeping: Always lay your baby down to sleep on her back. This is important to prevent sudden infant death syndrome (SIDS). However, you should change your baby's head position each time you lay her down. Lay your baby with her head towards the top of the crib one time, and the next time lay her down with her head at the other end. Babies like to look out towards the room and this way your baby is likely to move her head to a different side each time she is laid down. Put toys or mirrors around the room to help your baby want to look towards the outside of the crib. Keep soft objects, toys, and loose bedding out of your baby's sleep area.
• Infant seats, strollers, bouncy seats, and swings: Watch to see if your baby likes to put her head to the same side all the time while sitting. Roll up a blanket or use a neck roll to put around your baby's head to keep her head in the center. Don’t keep your baby in these seats for long periods.
• Tummy time: "Tummy time" is a time for playing with your baby. Start placing your baby on her tummy for playtime once the umbilical cord has dried up and fallen off. Time spent lying on the tummy helps develop neck, stomach, arm, and back strength. It also helps to get your baby ready for rolling, sitting, and crawling. Babies don't like lying on their tummies at first because they are weak and it is hard for them to push up. Don't worry if your baby fusses some of the time. Start putting your baby on her tummy for 2 to 3 minutes at a time, 3 or 4 times a day. Try it after a feeding or a diaper change. Talk to your baby, place toys in front of her, and encourage her to lift her head and try to push up. Slowly increase the time spent on the tummy and your baby will get stronger. Don’t let your baby fall asleep while lying on her stomach.
• Carry your baby: Your baby's favorite place is your arms. Holding your baby or carrying your baby in a front pack is a great way to help her hold her head in different positions.