Positional Plagiocephaly

Flat head syndrome, also known as positional plagiocephaly, is a condition where one side of a baby’s head is flat. Babies are vulnerable to plagiocephaly because their skulls are soft and malleable at birth. Flattening can occur when there is crowding in the womb or when the baby is placed in the same position (such as on their back) for extended periods of time.

Sometimes babies can develop positional plagiocephaly when movement in the womb is constricted.  This can occur when there is:

• Cephalopelvic disproportion (CPD)
• Oligohydramnios (low fluid in the womb)
• Multiple babies in the womb
• Prolonged course of labor
• Macrosomia (when the baby is large for gestational age).

Physicians are supposed to pay close attention to the health and well-being of the baby during prenatal tests. Failure to recognize these conditions in time can result in the baby experiencing preventable head trauma. These circumstances may require the baby (or babies) to be delivered early via C-section to avoid a birth injury. Medical professionals must monitor the position and well-being of these babies and deliver them when they are in distress or experiencing trauma can cause them to have permanent head injuries.

Positional plagiocephaly is usually caused by a baby spending too much time in one position, with pressure being put on one part of the skull for long time periods.  Since babies spend so much time lying on their back, for example, they may develop a flat spot where the head presses against the mattress.  The flattening typically is to one side of the back of the head, and some facial asymmetry often occurs as well.  Brachycephaly occurs when the baby has a very wide head shape with a flattening across the entire back of the head.

In the early 1990s, parents were told to keep their babies on their back as part of the anti-Sudden Infant Death Syndrome (SIDS) recommendations.  This advice saved thousands of lives, but medical experts have noticed a fivefold increase in misshapen heads.

Almost all cases of positional plagiocephaly can be prevented (and sometimes corrected) by utilizing repositioning techniques to relieve pressure from the back of the baby’s head.  Repositioning techniques include the following:

• Giving the baby “tummy time” when they are awake and has someone watching them.  In addition to helping prevent flat spots, tummy time helps the baby’s shoulder, neck and head muscles get stronger as part of normal muscle development.
  • Parents can give the baby tummy time two or three times a day, for short durations, until the baby gets used to this position.  Once the baby begins to like tummy time, parents can increase the length of time the baby is on their tummy and / or the frequency.
• The direction that the baby lies in the crib should be changed every week.  For example, for a few days, the baby’s feet should point in one direction, and then for the next few days, the baby’s feet should point in the opposite direction when sleeping.  This position change will encourage the baby to turn their head in different directions to avoid resting in the same position all the time.
• Too much time in car seats, carriers and bouncers should be avoided when the baby is awake.
• Parents can change the location of the baby’s crib in the room so the baby has to look in different directions to see the door or window.

Many babies who experienced a vaginal birth are born with misshapen heads due to the pressure of passing through the birth canal.  This typically corrects itself within approximately six weeks.  If a baby’s head hasn’t rounded out after six weeks, or if a flattening of the head is noticed after a baby is six weeks old, the probable cause is positional plagiocephaly.

Babies that are most likely to have positional plagiocephaly are babies with unusually large heads, babies who were born prematurely or who have weak muscle tone, and babies who are “good sleepers.”

Babies with torticollis are also at a high risk of positional plagiocephaly because they often sleep with their head turned to one side.  Torticollis is a condition whereby a tight or shortened muscle on one side of the neck causes the chin to tilt to the other side.  Babies born preterm are especially susceptible to torticollis.

Plagiocephaly will sometimes improve as the baby grows, but quite often, treatment can significantly improve the shape of the baby’s head.  Treatment initially involves re-positioning techniques to reduce pressure on the affected area.

If re-positioning is unsuccessful, cranial remolding using a baby helmet can help correct abnormal head shapes.  Helmets can be used on babies who are 3 – 18 months of age.  A custom-made helmet prevents the baby’s head from falling to one side when lying down and it allows the skull to expand into a more rounded shape as the brain and skull grow.