Flat head syndrome

Placing your baby to sleep on her back is vital for safe sleeping – since the American Academy of Pediatrics (AAP) launched its Back to Sleep campaign in 1992, this simple safety measure has reduced the incidence of sudden infant death syndrome (SIDS) by 40%.

However, sleeping on their backs, in combination with spending a lot of time in car seats and baby swings, put babies at risk of a condition called flat head syndrome – officially known as brachycephaly if it involves the back of the skull and plagiocephaly if it occurs towards the back at one side of your baby’s head. A 1996 study suggested that the incidence of flat head syndrome increased six-fold after Back to Sleep was implemented and more recent figures suggest that as many as 48% of babies may have it and the AAP recommends that pediatricians screen for it at the 2 and 3-month well baby checkup.

What are the symptoms?

Flat head syndrome is where the back of a baby’s skull takes on a flat appearance due to the pressure placed on it when she is lying on her back – if your baby has brachycephaly, then when you look down on her from above you’ll see that her head is wider and flatter at the back and it may also be slightly higher towards the back of her skull too. If she has plagiocephaly her skull will take on a slanted appearance at one side, with a slightly bulging forehead on the same side as the slant. Preemies are particularly at risk of developing flat head syndrome, as are any full-term babies who naturally have a slightly flat head at the back.

Prevention tips

As a rule, think ‘back to sleep, tummy to play’. Always lay your baby to sleep on her back even if she has flat head syndrome – it’s vital to help prevent SIDS. Turn her head to the right one night and the left the next, and so on. If she tends to turn her head to one side herself as she sleeps, you might be able to trick her into facing it the other way if you place her at the opposite end of the crib every other night, with a toy in her line of vision to attract her attention.

While your baby is awake, ensure she gets plenty of tummy time once her cord stump comes away. This will take the pressure off the back and side of her skull while also helping strengthen the muscles she needs for head control, rolling and crawling. Always supervise her when she is on her front – never leave her alone, not even for a second.

She may be a little distressed at first, if she isn’t used to seeing the world from this new position, so sing to her and place toys in her line of vision to distract her and give her something to focus on. As she gets stronger, hold a toy and move it from side to side in front of her face to encourage her to follow it with her yes and move her head from side to side. Other good ways of building tummy time into your baby’s day are by laying her across your lap to wind her, and laying her on your chest while you lie on the bed (this also is a lovely bonding experience for both of you). As she gets bigger and stronger, prop her up with a folded towel under her chest or with her arms draped over the side of her play nest or boppy.

Avoid leaving your baby in her car seat or infant swing for prolonged periods and when she is in either of these, ensure you use the body support to prevent her from slumping to one side.

Treatment

If you notice that your baby’s head seems to be flattened in one area, consult your pediatrician. In rare cases, skull malformations can be caused by another condition called craniosynostosis, which can occur if a baby’s fontanels (soft spots) close up too rapidly. It’s vital to get this diagnosed and treated, as it means your baby’s brain won’t have the space it needs to grow. This can cause problems with vision and intellectual development. Craniosynostosis can also signal an underlying health condition.

If your pediatrician thinks your baby is at risk of flat head syndrome she’ll advise you on ways to ensure your baby gets enough tummy time, and she may refer you to a pediatric physical therapist.

Once your baby is able to sit up by herself and crawl, it’s likely her head will take on a less flattened appearance but if preventive measures aren’t working she may be fitted for a special helmet called a cranial molding orthosis. This needs to be worn full-time (even for sleeping) for up to six months depending on how severe the problem is, and will help to gently guide your baby’s future skull formation and shape. Once your baby is over 1, it’s unusual for a helmet to be recommended as skull growth slows from then on.

The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.

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Last Modified: 27/08/2008

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