Flattened Head Syndrome in Babies

December 22, 2011 — Due to the “Back to Sleep” campaign to prevent Sudden Infant Death Syndrome (SIDS) in babies, more infants are developing positional deformities of the skull, known as plagiocephaly. Flattening of the back of skull (occiput) is the most commonly seen positional deformity, sometimes more pronounced on one side or the other. When babies have an associated wryneck, known as torticollis, they the to have shortened muscle in the neck that can cause a baby to tend to want to hold their head looking to one side. This can aggravate the flattening as they tend to want to spend more time looking in the same direction. Studies have not shown that positional skull deformities is a cause of developmental delay.

Starting at birth, most positional skull deformities can be prevented by working on ways to keep a baby from always laying on one section of the head. Here are some tips:

  • Sleep babies on their back, but try to alternate them looking to right and left side when they sleep. (This is not the same as sleeping on the side).
  • When awake, they should spend supervised time on their tummies for at least 30-60 minutes/day. Routine awake tummy time has been shown to enhance infant motor developmental scores during the first 15 months of life.
  • Babies should spend minimal time in car seats when not in the car.

The prevalence of positional skull deformities generally peaks at 4 months and will begin to show more improvement by 6 months as babies spend more time sitting and then crawling. If positional skull deformity is found, most infants improve if other measures are started. These include:

  • Positioning so that the more rounded side of the head is placed against the mattress.
  • Change the crib position and place the infant more often so that the baby will look away from the flattened side to see people or interesting objects in the room.
  • Continue to encourage supervised tummy time when awake.
  • If a torticollis which is the tight neck muscle has also been identified, neck stretches can be performed. These should be done with each diaper change. There are 3 repetitions per exercise and hold each position for about 10 seconds. It is estimated that it will take about 2 extra minutes per diaper change. Basically, the child’s head is rotated gently so that the chin touches the shoulder (each side) and then the other exercise is rotating the head so the infant’s ear touches the shoulder (each side). Here is a YouTube video to describe these stretches.

If positioning and exercises are not helping, sometimes physical therapy is recommended and then the final treatment if skull deformities are more significant and not improving can be referral for a skull-molding helmet.