Newborns: Flattened Head Syndrome

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KEY POINTS

• If your baby has a flat spot on the head that doesn’t go away a few weeks after birth, your baby may have a condition called flattened head syndrome, or positional plagiocephaly.
• Your baby’s treatment may include head positioning, exercises and stretching, or wearing a helmet to change the shape of your baby’s head.
• You can help prevent flattening by changing your baby's head position from time to time.

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What is flattened head syndrome?

If your baby has a flat spot on the head that doesn’t go away a few weeks after birth, your baby may have a condition called flattened head syndrome, or positional plagiocephaly.

What is the cause?

Babies have very little room inside the uterus toward the end of pregnancy and may get stuck in one position. Twins or babies who are in a breech position (bottom down) have less room to move around and cannot change position.

Some babies have tight or shortened neck muscles (torticollis) when they are born. This causes the baby to lie on one side and can result in a flat spot on one side of the head.

Some babies lie in one position most of the time after birth. A newborn's head is soft and easily molded into a flat shape. Your baby’s head can get flat on the back or on one side from being on his or her back with the head in one position for a long time, day after day. This can cause the forehead and face to look crooked.

What are the symptoms?

You can start to see flattening as early as 6 weeks of age. You may notice changes in your baby’s face within the first 3 to 6 months.

How is it diagnosed?

Your healthcare provider will review your child’s symptoms and medical history and examine your child. Many babies have some flattening and usually they do not need medical treatment for it.

How is it treated?

Your healthcare provider will tell you how to change your baby’s head position, and how often to do this. Often, this is the only treatment your child will need.

In some cases, your baby may need special stretching exercises or positioning if the neck muscles are tight or shortened or have been very cramped in the uterus.

Your baby may need a helmet that can help reshape the head if the flattening is affecting your baby’s face or causing one ear to be further forward than the other ear. Your baby may also need a helmet if he or she has a twisted neck that causes the head to turn to one side.

How can I help my child?

You can help prevent flattening by changing your baby's head position from time to time. This is especially important when your baby is very young and cannot move around a lot.

Here is what you can do to keep your baby from lying in one position too long:

• Sleeping: Always lay your baby down to sleep on his or her back. This is important to prevent sudden infant death syndrome (SIDS). However, you should change your baby's head position each time you lay your baby down. Lay your baby with the head toward the top of the crib one time. The next time lay your baby down with the head at the other end. Babies like to look out toward the room, so your baby is likely to move his or her head to a different side each time. Put toys or mirrors around the room to help your baby want to look toward the outside of the crib. Keep soft objects, toys, and loose bedding out of your baby's sleep area.
• Infant seats, strollers, bouncy seats, and swings: Watch to see if your baby likes to put his or her head to the same side all the time while sitting. Roll up a blanket or use a neck roll to put around your baby's head to keep the head in the center. Don’t keep your baby in these seats for long periods.
• Tummy time: "Tummy time" is a time for playing with your baby. Start placing your baby on the tummy for playtime once the umbilical cord has dried up and fallen off. Time spent lying on the tummy helps develop neck, stomach, arm, and back strength. It also helps to get your baby ready for rolling, sitting, and crawling. Babies don't like lying on tummies at first because they are weak, and it is hard for your baby to push up. Don't worry if your baby fusses some of the time. Start putting your baby on the tummy for 2 to 3 minutes at a time, 3 or 4 times a day. Try it after a feeding or a diaper change. Talk to your baby, place toys in front of your baby, and encourage your baby to lift his or her head and try to push up. Slowly increase the time spent on the tummy and your baby will get stronger. Don’t let your baby fall asleep while lying on the tummy.
• Carry your baby: Your baby's favorite place is your arms. Holding your baby or carrying your baby in a front pack is a great way to help hold his or her head in different positions.