Has your infant been diagnosed with plagiocephaly? It is more common than you think.  Here’s all you need to know about plagiocephaly to put your mind at ease.

What is plagiocephaly?

Plagiocephaly, or ‘flat head syndrome’ is when one side of the skull is flattened. Nearly 50% of all infants are affected by plagiocephaly, usually due to being in the supine position too often for too long. The flattening most often occurs at the back or on the side of the head.

Who does it affect?

Many infants are born with a “diamond-shaped” head or a flat side. Plagiocephaly is routinely diagnosed, and usually, it corrects itself within a few months. However, babies who are consistently kept on their backs may develop plagiocephaly, with a flat spot on the back of their heads. The incidence of plagiocephaly has increased with the “back is best” or “back to sleep” movement of recommendations for parents to keep infants on their backs during sleep for reduced risk of crib death.

What causes plagiocephaly?

Many things can cause plagiocephaly. Most of them are unavoidable and have nothing to do with the parent. The baby’s position in the womb can cause him to develop plagiocephaly. If they are stuck in one position for a long time or if they are stuck in there with a twin, they may be born with plagiocephaly. Premature babies are also at greater risk for plagiocephaly because they have very soft skulls, making them more vulnerable to misshaping. If babies are in the neonatal unit on a respirator for a long time, they are likely to develop plagiocephaly. A condition called torticollis—when the neck muscles are very tight—can also lead to plagiocephaly, because your baby will tend to turn her head to one side, causing flattening on the other side. Babies who are put on their backs too often and for too long are also at risk for developing plagiocephaly.

Will it affect development?

In mild cases, at a very early age (before five months), probably not. Most of the time, the condition corrects itself with plenty of tummy time and repositioning. In cases of moderate to severe plagiocephaly, or cases in which the child is older, there may be repercussions on neurological development. There may be a link between flat head syndrome in children over a year old and delayed neural development, especially in motor function. There is also increased risk for jaw asymmetry or TMJ, scoliosis, sleep apnea, visual defects, and middle ear abnormalities.

How can plagiocephaly be prevented?

Most reported cases are positional—meaning, that baby’s flat head is directly due to how his caretaker positions him. That’s good news. It means that with repositioning, your baby will probably not develop plagiocephaly. While he is awake, give him plenty of tummy time. Each time you bottle-feed, switch sides so that he is not always feeding on the same side (this happens automatically with breastfeeding). Don’t leave your baby for too long in the car seat, swing, or carrier, where his head rests in the same spot for a long time.

How can plagiocephaly be treated?

Repositioning is the first line of treatment. Changing your baby from place to place, from back to tummy, and switching sides in the crib so that she turns her head in a different direction to see the room and her parents. If your baby has torticollis, physical therapy can be helpful in getting her to turn her head in the direction she would normally avoid. The next line of treatment is with cranial remolding orthosis, or baby helmets. This type of treatment is used to treat all sorts of head deformities until the age of 18 months. During treatment, the baby is required to wear the helmet for 23 hours a day, for 2-6 months depending on how severe the deformity is, and how early treatment was started.

When is the best time to treat plagiocephaly?

Up until age 18 months, your baby still has a very soft and pliable skull. This means that any flattened spots may still be corrected. Babies age 3-18 months are candidates for receiving a baby headband or helmet. After 18 months, your baby will not be eligible to start cranial remolding orthosis. By the age of two years, your child’s head shape is fully formed.

Is cranial remolding orthosis uncomfortable for my baby?

In the beginning, probably. However, the younger your baby is, the less resistance he will put up when you introduce the headband or helmet.  Keep in mind that these helmets are specially designed for tiny infants—like yours. They’re lightweight, and they shouldn’t restrict movement at all. Your baby will most likely get used to the helmet within a few days.

How can I tell if my baby’s plagiocephaly is improving?

Every week, take a picture of the top of your baby’s head. This will give you a good idea if the flattened part is rounding out, or if it is remaining unchanged. If you see no change, or if it is getting worse, a visit to the pediatrician may be in order.

What will happen if I don’t treat my baby’s plagiocephaly?

If your baby’s flat head syndrome is moderate to severe and is left untreated, he will carry the deformity into adulthood. Later on, it can cause your child to have a noticeably asymmetrical face. He may not fit well into glasses, helmets, or protective sports equipment. It may also cause jaw misalignment, TMJ, or an underbite.

In most cases, plagiocephaly will correct itself but talk to your pediatrician about treatment if you think your baby might need it.