The birth process may cause your baby’s head to appear slightly misshapen during the few days or weeks after he or she is born. This generally is normal because a baby’s skull is made up of several separate bones that are not yet fused together. The shape should improve within six weeks of birth. If you’ve noticed that your baby is developing a persistent flat spot or is born with a flat spot that does not improve, it could be a sign of positional plagiocephaly, also known as flat head in infants.
Positional plagiocephaly most often occurs when a baby sleeps or rests his or her head in the same position repeatedly. Other common causes include:
• Decreased space in the womb, such as multiple births or breech position.
• Premature birth.
• Torticollis (tightness of neck muscles causing the head to tilt and/or turn one way more than the other).
What does positional plagiocephaly look like?
An infant’s skull may get flat along the back, one of the sides or may bulge out at the forehead. If you look at your baby from above, one of his or her ears may seem more forward than the other. From the front, the eyes, jaw and cheeks may be uneven between the left and right side.
How can positional plagiocephaly affect my baby?
Small differences are normal, but severe flatness may cause future problems. Since the jaw is connected to the skull bones, the jaw can become uneven as the skull gets flat. This could cause pain in the jaw and make it hard to chew and eat. Uneven eyes may cause vision problems. Uneven head shape makes it difficult for glasses and safety helmets, such as a bike helmet, to fit correctly.
Can I prevent positional plagiocephaly?
Fortunately, positional plagiocephaly usually is easy to treat. With appropriate intervention, it should be corrected by the time your child is 1 year old. Parents may try the following suggestions:
• Alternate the direction your baby’s head is turned each time he or she sleeps.
• Encourage your baby to look in all directions when he or she is awake.
• Alternate the arm you use to feed or hold your baby.
• Consider moving your baby’s crib to a different area of the room. If there’s something in the room that’s catching his or her attention, moving the crib will coax your child to look at it from another position.
• Use items like bouncy seats and swings as little as possible. Use the car seat only in the car, not as a carrier or for sleeping.
• Use an upright carrier (ex: Snugli® or Baby Bjorn®) instead of a stroller when out for walks.
• Be sure your baby gets plenty of supervised “tummy time” during the day. Tummy time helps promote normal shaping of the back the head. In addition, it helps babies learn to push up on their arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen the neck muscles.
As babies grow, they typically begin to reposition themselves naturally. Talk to your pediatrician if you see your baby turning or tilting his or her head more in one direction or if you notice head flatness developing.
FAST FACT: Always place your baby on his or her back to sleep. This decreases the chance of SIDS by 40 percent.
Micki Klawes, MPT, is a physical therapist at Children’s Hospital of Wisconsin.