Infant Head Shape Concerns: Signs and Treatments

It’s Cleft and Craniofacial Awareness Month, and we’re here to provide you with information and tools should your baby develop a flattened shape or appearance on their head. This condition is called positional plagiocephaly, or sometimes incorrectly referred to as “flat head syndrome,” which causes a baby’s head to be slightly misshapen.

Read on for symptoms and causes of infant head shape concerns, dos and don’ts for preventative measures and what treatment options are available.

Common Causes of Positional Plagiocephaly

The most common cause of variation in infant head shape is a condition called positional plagiocephaly. It happens when a baby's head develops a flattened spot from repeated pressure on that specific area. Babies are vulnerable because their skull is soft and pliable when they’re born.

Positional plagiocephaly typically develops after birth when babies spend a lot of time in a position that puts pressure on one part of the skull. Because little ones spend so much time lying on their back, they may develop a flat spot where their head presses against the mattress. Overuse of car seats, swings and other convenience items can contribute to the development of flat spots.

Starting in the early 1990’s, parents were told to put their babies to sleep on their backs to reduce the risk of SIDS (sudden infant death syndrome). While this advice has saved countless lives, the incidence of positional plagiocephaly has equally increased by five times since then. Despite these findings, the “back is best” rule still applies since positional plagiocephaly is treatable and more importantly, not life-threatening.

Positional plagiocephaly can also develop during pregnancy when movement within the uterus is restricted, whether it’s due to an unusual shape of the uterus, crowding within the womb from multiple pregnancies like twins or breeched positioning.

Another cause of an irregularly shaped head is craniosynostosis, a congenital condition where the sutures between the bones of the skull fuse too soon. Babies who are born with craniosynostosis need a very different course of treatment. Surgery is often needed to allow their brains the proper room to grow.

Signs of an Irregular Head Shape

While some babies are born with irregularly shaped heads from natural delivery, their head shape usually corrects itself within six weeks. If your baby's head hasn't rounded out by six weeks of age — or if you first notice that your baby has a flattened spot on their skull after this time period — they may be developing positional plagiocephaly.

Positional plagiocephaly shows up most often in babies who are "good sleepers” and preemies with weak muscle tone. Babies can also develop a flattened spot on their skull if they often sleep with their heads turned to the same side.

Treatments for an Irregularly Shaped Head

Babies’ skulls become less soft and pliable as they grow. If you need to take steps to correct the condition, the younger your baby is, the easier it will be. Your pediatrician may refer you to a specialist, such as a physical therapist, pediatric plastic surgeon or neurosurgeon for diagnosis and treatment.

Some treatment options include:

Repositioning Therapy:

Repositioning therapy involves regularly changing your baby's position to avoid putting pressure on the flattened area of the head. Some ideas for changing routines and strengthening their neck muscles are:

• Bedtime and naps: Alternate the direction your baby's head is facing (keeping safety in mind) when you put them to sleep. Lay them down with their head at a different end of the crib during naps and bedtime.
  
• Feeding time: Alternate sides whenever you feed your baby a bottle or breastfeed. Adjusting your baby's position during feeding helps avoid repeated pressure on the same spots.
  
• Physical therapy: Their pediatrician may also recommend daily physical therapy exercises to help increase the range of motion in your baby's neck. These exercises must be done gently but consistently.
  
• Sitting time: Avoid leaving your baby for extended periods of time in a car seat, infant seat, baby swing, baby carrier or other places where their head is likely to rest on the same spot.
  
• Tummy time: Supervised tummy time is great for the development of fine motor skills. Tummy time also helps prevent flat spots by strengthening babies' neck muscles. Stronger neck muscles enable babies to move their head around while sleeping so it doesn't always rest in the same position.

If these measures aren't successful, the next step is to consider cranial orthotic therapy.

Cranial Orthotic Therapy:

Babies with ongoing flattening by five to six months of age may benefit from helmet molding therapy, and physical therapy if the flatness is severe. A professional evaluation is important to confirm whether your child has positional plagiocephaly and differentiate it from other conditions, such as premature fusion of the skull bones (craniosynostosis).

Cranial orthotic therapy is the use of a baby helmet or headband that your baby wears up to 23 hours a day to correct severe cases of positional plagiocephaly. The treatment typically lasts two to six months.

Helmet molding therapy is always coordinated with physical therapy to achieve the best results. It's most successful when started around six months of age. Some experts think the headgear offers little help after 12 months of age because the skull resists reshaping as the bone thickens.

If your baby needs cranial orthotic therapy, your doctor can recommend a helmet or band and guide you through the treatment process. You'll need to have a 3D image taken of your baby's head so the device can be custom fitted.

The success rates for this kind of therapy are high when it's started early (around six months). If you start too late, your baby's skull may not become perfectly symmetrical. Keep in mind that some asymmetry is normal.

Compassionate, Personalized Care for Your Baby

At AdventHealth for Children, we know only the best will do when it comes to your little one. That’s why we offer comprehensive, gentle care tailored to your baby. With your child’s whole health in mind, we’ll present all the options that will help you make informed decisions you can feel good about.

We offer treatment for positional plagiocephaly, craniosynostosis and more. To learn more about our craniofacial care, click here.