What is Flat Head Syndrome?

Medically known as deformational plagiocephaly, flat head syndrome is one of the most common abnormal findings in babies and a frequent reason for parents to consult a pediatrician. A baby with flat head syndrome has a flat spot on one side or the back of the head.

Causes and risk factors

Some of the most common causes and risk factors associated with this condition include:

• The skull is flattened because the space in the uterus is tight, for example, if the mother has twins or triplets, if the labor is prolonged, or if the baby’s head is larger than average. In these cases, the condition is often self-limited and the baby’s head rounds out within six weeks.
• Flat head syndrome often happens because the baby’s head stays in one position for extended periods of time. An underlying condition, like a problem affecting the neck muscles can make the baby choose to stay longer in one position.
• If the baby is born premature, the skull bones are softer and the baby is more likely to stay in the hospital with the head in the same position for a long time.
• Babies who sleep on their back or are placed in a car seat and the parents or caregivers do not change their position, are also at risk to develop flat head syndrome. Researchers note this condition became more prevalent in the last few decades, since doctors started recommending that babies should sleep on their back to decrease the risk of sudden infant death syndrome (SIDS). While the incidence of SIDS decreased, and many lives were saved, the number of cases of flat head syndrome dramatically increased.
• Congenital torticollis is a medical condition that is present at birth, characterized by tightness in the neck muscles. This condition makes the baby more likely to stay with their head in the same position for longer periods of time.
• Baby boys, the first born child, babies who were born with the use of forceps or vacuum extraction, those who are less active and lack tummy time are also more likely to develop flat head syndrome.

Signs and symptoms

A flat spot on either side or the back of the skull is the main sign of flat head syndrome. This flat spot can be present at birth or may develop in the first few months.

As the baby grows, they will start moving more and changing the position, reducing the pressure on the flat spot. However, if the head deformity is moderate to severe, early treatment is needed.

Diagnosis

The parents are often the first to notice the flat spot on the baby’ skull and seek medical advice. A pediatrician will perform a physical examination, evaluating the baby’s head shape from all positions, and palpating the skull. The doctor will also measure the baby’s head to assess how serious the deformity is.

Treatment

The treatment depends on the severity of the symptoms, the baby’s age and overall health.

• Mild cases are often self-limited, and go away once the baby starts to sit up and move. In other cases, doctors recommend changing the baby’s position during sleep and turning the baby’s head to the opposite site. In addition, babies should spend time on their stomach when they are awake, under a parent or caregiver supervision.
• If the above recommendations are not enough, the baby may benefit from wearing a special band or hamlet which helps remodel the head. Helmets are available by prescription only, and are typically used for babies who are three to 18 months of age. These helmets should be used for three to six months.

What happens if flat head syndrome is left untreated?

Mild, self-limited cases require little or no treatment.

If the case is severe, the head deformity should be treated early to avoid complications. Research studies found evidence that flat head syndrome may be associated with developmental delay, and children with this condition are more likely to require special education assistance, speech therapy and occupational therapy during school years.

Having abnormal head shape can affect the child’s ability to wear protective headgear required for sports like cycling or working in construction because those protective helmets are designed to fit a regular, symmetric shape of the head. Furthermore, having a noticeable flat spot on the head can affect the psychological well-being of the child.

Health experts recommend the ideal age to start treatment between four to seven months, although the treatment can start later, up to 14 months of age. Early treatment means more opportunity to correct the shape of the head .

Prevention

Parents can use the following tips to prevent the development of flat head syndrome in their babies:

• Allow the baby to have tummy time under supervision. Parents can give the baby tummy time a few times a day for a short duration, so the baby has the opportunity to get used to this new position. Once the baby starts to enjoy tummy time, the duration can be increased. In addition to preventing flat head syndrome, tummy time also strengthens the muscles of the shoulders, neck and head.
• Reduce the amount of time the baby spends in car seats, carriers and bouncers.
• Encourage the baby to stay active, more around and spend time upright.
• Moving the crib in the room can help the baby move more, look in different directions to see the window or the door.
• Moving the baby’s position in the crib can also make the baby turn their head in different directions.

Flat head syndrome is a common condition, but can be prevented, and if it occurs, it can be effectively treated. Parents should seek medical advice if they notice any changes in the shape of the baby’s skull.