What Parents Need to Know About Flat Head Syndrome

You may have seen an infant wearing a tiny helmet resembling those worn by your favorite sports star, but these devices offer more than head protection from a sudden impact. They are a cure for flat head syndrome.

With flat head syndrome, formally called positional plagiocephaly, flat spots develop on the back or side of a baby's head, usually by the time the infant is 4 months old. In 2013, the journal Pediatrics published a study that estimated roughly 47 percent of babies have this condition.

This percentage may seem surprisingly high, and there's a reason cases have been growing for the past 24 years. In 1992, the American Academy of Pediatrics recommended that parents should put infants to sleep on their backs to prevent sudden infant death syndrome, or SIDS. Steve Kwon, MD, a board-certified pediatrician at St. Jude Heritage Medical Group, says, “Infants' skull bones are soft to accommodate future growth, so if babies sleep on their backs and tend to lie in the same position because they can't yet roll over or move their head, the bones can be molded and flattened over time."

That's not the only cause of flat head syndrome. Dr. Kwon adds that multiples such as twins and triplets can have flat spots from their cramped position in the womb. Babies born prematurely have softer skull bones, making them more likely to develop the condition.

"A pediatrician can diagnose the condition by looking at the child's head, but parents may notice signs, too: The back of the head isn't symmetrically rounded, there's hair loss on one side of the head or the ear on the flattened side of the head may jut forward," Dr. Kwon says. "If parents suspect there's a problem, they should set up a doctor's appointment as soon as possible--treatment should begin between the ages of 4 months and 12 months, while the bones of the skull are still soft."

Infant helmets are actually prescribed by doctors for more advanced cases of flat head syndrome. If a baby has a milder form of the condition, or if parents want to take preventive action, Dr. Kwon recommends the following ideas:

• Give babies a lot of tummy time. Until an infant can roll over independently, some play time while laying stomach-side down is recommended, with parent supervision. Newborns can spend a few minutes each day laying on their bellies in a parent's lap, working up to 20 minutes of daily tummy time on a safe surface, such as a blanket on the floor, by the time they are about 4 months old. "It also helps strengthen many muscles in the baby's upper body, such as the neck and shoulders," Dr. Kwon says.
• Change sleeping positions. "Parents of younger infants can place the baby's head a certain way when setting them in the crib--tilted toward the right one day, then facing left the next," Dr. Kwon says. "If there's already a flat spot, try to keep that side facing up as much as possible. Parents should never stop putting babies to sleep on their backs."
• Keep babies upright. "Babies don't just rest on their backs in cribs, but in strollers, car seats and baby swings, too," Dr. Kwon says. "When parents hold the baby in their arms, it takes some of the pressure off the head and gives less time for a flat spot to form. Generally, flat spots tend to not be an issue once babies begin sitting up and rolling over, and can move their head more."
• Follow doctor's orders. Sometimes, a pediatrician will give parents stretching or physical therapy exercises to do with the infant at home. "Babies with flat head syndrome can also end up with tight neck muscles, a condition that's called torticollis," Dr. Kwon says. "If those muscles aren't loosened up, it's harder for the baby to move his or her head and flat spots can continue to worsen."

"Parents should know that flat head syndrome doesn't cause brain damage, nor does it mean the baby has stunted brain growth or delayed-development issues," Dr. Kwon says. "And it's worth reiterating that parents should never put their child to sleep stomach-side down to avoid flat head syndrome. It may seem like an easy fix for the problem, but the chance of SIDS isn't worth it. In most cases, these recommended tips can solve flat head syndrome." 

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.