What is Flat Head Syndrome?
What is Flat Head Syndrome?
In the 23 years that I’ve been practicing pediatric physical therapy, the incidence of Flat Head Syndrome has skyrocketed. Flat Head Syndrome is described as a flattening of the skull due to positioning. There are various types of flat head syndrome.
The two most common are:
Plagiocephaly: This is usually the result of Torticollis, which is when the neck muscles shorten on one side, causing the baby's neck to turn in a twisted position, tilting his head to one side with his chin pointing to the other side. The head is flattened on one side, causing it to look asymmetrical; the ears may be misaligned and sometimes the forehead and face may bulge a little on the flat side. Torticollis, if left untreated, can lead to issues in motor development. Torticollis will be discussed further in a future newsletter. Brachycephaly: This is when the back of the head becomes flattened, causing the head to widen.
Why are so many babies developing flat spots?
No one knows for sure why so many babies are developing Flat Head Syndrome. I believe it is a combination of two main factors:
1. Many people believe that the Back to Sleep/Safe to Sleep campaign to combat SIDS has played a significant role. I agree that this is a significant factor because newborns spend so much time sleeping, and the supine position puts more pressure on the back of the head, increasing the risk of flattening. **Please note that even if your baby is exhibiting signs of Flat Head Syndrome, you should continue to put her on her back to sleep. 2. The Plethora of Baby Positioners on the market: I describe baby positioners or “containers” as any of the gear available that supports your baby in a semi-reclined position and restricts his movement and ability to interact with his environment (swings, bouncy seat, rock-n-play, etc). In this position, gravity plays a more significant role, making it even more difficult for your newborn to keep his head in midline. “Containers” limit your baby’s ability to actively move and naturally stretch out of the subtle asymmetries present at birth. Instead, they support him comfortably in his preferred position for long periods of time putting pressure on the back of the his skull. Because a baby’s skull is so soft, he can quickly develop a flat spot from this gentle pressure.
How Can I Prevent My Baby from Developing a Flat spot?
Monitor your baby’s head shape: Many new parents don’t even know that they should be monitoring the shape of their baby's head. I encourage parents to take a picture each week so they have a frame of reference for comparison. A photo from the front as well as a bird’s eye view will help you determine if there are any asymmetries in the skull shape.
Encourage tummy time: Because our babies are sleeping on their backs, it is more important than ever to give them time off the backs of their heads during waking hours. Many babies are resistant to tummy time so it is important to help them find ways to do this comfortably.
Try putting baby over your lap or on your chest for tummy time.
Give him gentle pressure on his bottom to help take some of the weight off his shoulders and head which makes it a little easier for him.
We don’t want tummy time to be a stressful time for your baby, so if he continues to be resistant, give him many short sessions of tummy time throughout the day, rather than leaving him on his tummy in distress.
Encourage Sidelying Position: Sidelying is an often forgotten position. This is often more tolerable to babies and will help eliminate pressure on the back of the skull during waking hours.
Limit use of “Containers”: As a mom, I know it is not realistic to ask any parent to completely eliminate the use of containers. However, I do encourage parents to limit the use to less than 2 hours per day and to be mindful of HOW your baby is positioned while supported in the positioner.
Positioning Do's and Don'ts
DO Position baby so his head Don't Allow your baby to sit in a and trunk are supported
semi-upright position without support
Make sure to position your baby so he is straight. If he is unable to maintain this position independently, use an external support pillow to keep him aligned properly.
What should I do if I notice a flat spot?
If you notice a flat spot on your baby’s head, do your best to be more diligent about keeping him out of the “containers” and make sure to give him lots of tummy time. Try wearing your baby in a carrier or sling for longer periods of time. If the flat spot is asymmetrical, make sure to encourage him to look to the opposite side. Pediatricians often take a "wait and see" approach. I strongly recommend a PT evaluation be done right away to rule out any underlying issues such as Torticollis or low muscle tone. The evaluation should take place in the home, where the therapist can observe the child in his natural environment. The baby can be assessed in his crib, high chair, swing, changing table, etc and adjustments can be made to improve positioning in these devices before further flattening and asymmetries occur. In my experience, a little intervention goes a long way. I can often instruct caregivers in appropriate stretches and set up the baby's environment appropriately in just a few sessions. EARLY DETECTION is the key to success!! If my baby has a flat spot will she need a helmet?
I feel strongly that with EARLY DETECTION and treatment, the majority of babies can avoid the need for a baby helmet (cranial orthosis or cranial band). I believe that cranial bands can be a successful treatment option when repositioning and physical therapy have not fully corrected the head shape deformity. Again, I cannot stress enough that the sooner the problem is addressed, the better chance you have of avoiding a baby helmet.
If you know a child that could benefit from physical therapy, and lives in Westchester County, please call (917) 584-3468 and I will be happy to help answer any questions. If you’ve found this article helpful, please go to my website and join my mailing list to receive future articles. Darcy Froehlich, PT, C/NDT
