What is Flat Head Syndrome?

The skull protects the brain, but it is also malleable because of connective tissue between the skull bones known as sutures. This is the reason why the brain can grow/develop and also allow the head to be shaped during delivery, but also make the baby’s skull to be vulnerable to deformation.” (Laughlin, J., et al 2011.)

Given the malleability of an infant’s skull in the early months of life, external forces can shape it quite easily.

There are 2 main types of Flat Head Syndrome:

• Plagiocephaly – presents as a flattened appearance on one side of the baby’s head, causing it to look asymmetrical; the ears may be misaligned and sometimes the forehead and face may bulge.
• Brachycephaly – the back of the head becomes flattened, causing the head to widen, and can also sometimes cause the forehead to bulge out.

What Causes Flat Head Syndrome?

This flattening can occur when infants spend a considerable amount of time in the same, static position, leading to pressure being applied to one part of the soft, pliable skull. While more commonly developing from repeated resting in the same position, it can also be caused by the moulding forces which are applied on the developing skull inside the utero or during birth while navigating the birth canal.

These problems are quite common, with studies suggesting it affects 1 in every 5 babies.

In most cases it is not a huge cause for concern and it is quite a mild deformity. This condition has no effect on the brain and the head shape will often improve by itself over time, especially once the baby’s head control develops and they can start to sit up and lie on their tummies.

It is important to stress that your baby will not experience any pain or other symptoms, or any problems with their general development.

“Families are often concerned that positional skull deformity may cause developmental delays. Although there have been no rigorous prospective studies to address this concern, there is currently no evidence to suggest that positional skull deformity causes developmental delays.”

Risk Factors for Developing Flat Head Syndrome

• Premature babies are more likely to suffer from this condition because their skulls are less developed. They also spend more time lying down in the hospital and at home.
• Torticollis – Some babies are born with or develop a condition called congenital muscular torticollis. It occurs when tightening in your infant’s neck muscles causes their head to twist and rotate to one side. This leads to neck stiffness and reduced neck movement, making it more likely that your baby’s head will stay in one position when lying down and sleeping. Torticollis can be treated effectively with physical therapy.
• Pregnancy with multiples – less space for movement and change of position in the womb.
• Forceps or vacuum delivery – Having an assisted delivery can cause the baby’s head to be delivered with a mild deformity.
• Low level activity and lack of tummy time – staying in prolonged positions on the back is the primary cause of this condition.

How Is Flat Head Syndrome Diagnosed?

The early detection of Flat Head Syndrome is important and is often initially identified by your health visitor or maternity nurse shortly after birth. However, parents also play a vital role in noticing any unusual shapes or flat spots on their baby’s head.

You may notice the flattening of your baby’s head by 6 to 8 weeks of age. There are no specific tests

Early identification allows for the timely implementation of corrective measures, potentially lessening the need for longer term treatment.

Severe Cases and Further Investigations

In rare instances, Flat Head Syndrome can indicate a more severe condition, such as craniosynostosis, where the skull bones fuse prematurely in an abnormal position. Such cases require further medical evaluation and, possibly, surgical intervention to correct the bone structure and allow for normal brain growth.
This is a very rare situation, and highly unlikely to develop, especially if detected early and managed appropriately.

How Do We Treat Flat Head Syndrome?

A common question among concerned parents is whether Flat Head Syndrome will self-correct. As infants grow, begin to sit up, and spend less time lying on their backs, the pressure on the flattened area decreases, often resulting in natural improvement of head shape. This improvement underscores the importance of early intervention and consistent monitoring.

Treatment for Flat Head Syndrome often involves a combination of physiotherapy and positioning advice. Through a comprehensive assessment, physiotherapists can offer personalised strategies aimed at alleviating pressure on the affected areas of the head. Such strategies may include promoting tummy time, alternating head positions during sleep, and ensuring ample supervised awake time off the back.

“The most commonly used physiotherapy techniques are exercises to improve motor development, active and passive mobilisation of the cervical spine, flexion and stretching, and manual therapy techniques in joints that have some limitations.” (Laughlin, J., et al 2011.)

Prevention focuses on varied positioning throughout the day to distribute pressure evenly across the infant’s head and avoiding prolonged periods in car seats, bouncers, or swings where pressure on the head can be intensified.

Empowering Parents Through Education

Understanding and addressing Flat Head Syndrome is a critical aspect of infant care. Armed with the knowledge of how to identify, prevent, and treat this condition, parents can play a proactive role in their child’s developmental journey.

Here are some useful tips:

• Change your baby’s sleep position often: You can change which end you put your baby down in their crib; babies are attracted to light and activity so they will turn toward windows or the middle of rooms. Your baby will look different ways depending on which way you place them down to sleep.
• Change your baby’s head position while they sleep: Gently move their head to the side they don’t usually favour.
• Strategically place toys and mobiles in their cot – this will encourage your baby to turn their head
• Hold your baby often: This limits the time your infant spends leaning against a flat surface. Hold and feed your baby in different positions, switching sides from time to time. You can also let your baby lie on your chest, or you can carry them in a carrier or sling.
• Provide lots of supervised “tummy time” while your baby is awake: Tummy time helps to strengthen your baby’s neck, arms and back making it easier for them to move their head and change position independently. It also gives your baby time off their back to offload the head.
• Reduce sleeping time in places where your baby’s head is restricted: Avoid too much time in curved baby swings or car seats.
• Strategically attract your baby’s attention: A mobile or other safe toy outside their crib may encourage your baby to turn and look.

While this condition is common and often corrects over time with appropriate measures implemented by parents, the involvement of healthcare professionals ensures that any underlying issues are addressed, paving the way for a healthy, happy infancy.