Here’s everything you need to know about flat head in babies – what causes it, how to remedy it at home and if any treatment is necessary.

When you become a parent, you are likely to have many concerns at the top of your mind. Is your baby gaining weight normally? Is she getting her vaccines on time? Am I feeding him right?

Among all these, the shape of your child’s head is unlikely to feature among your top ten concerns, until it is! We’re talking about flat head in babies, an extremely common condition that affects about 50% of babies worldwide.

What is Flat Head in Babies?

Flat head syndrome, technically known as plagiocephaly, is the appearance of a flat area on the back or side of a baby’s head. Flat head syndrome can be identified by these signs:

• The baby’s head is flatter on one side more than the other
• Hair growth is less on the flatter side, creating a bold spot
• The head appears misshapen or slanting, especially when looking from above
• Ears appear uneven or misaligned, with the ear on the flat side appearing to be pushed forward
• The nose may seem slanting to one side
• The forehead, cheek or eye may seem larger on one side
• In extreme cases, the neck or jaw may be affected

These signs aren’t visible at birth; they usually appear around 6 weeks after birth. Babies are most likely to get flat head before they are able to roll over, around four months of life.

The main reason babies get flat head is because of their soft, pliable skull bones. These soft bones make it easier for the baby to pass through the birth canal and also gives the developing brain space to grow. It is this nature of the skull that also makes it prone to changes in shape like flat head.

In a nutshell, flat head in babies is more of a cosmetic problem rather than a medical one. Flat head doesn’t affect the development of a baby’s brain in any way, but it may still be a concern for many parents.

Flat Head in Babies – Causes, Home Remedies and Treatment

Causes of Flat Head in Babies

There are two types of flat head in babies, and each one has a different set of causes.

Positional Plagiocephaly

Positional plagiocephaly, or deformational plagiocephaly, is the most common type of flat head syndrome, affecting 50% of babies. As its name suggests, this occurs due to positional reasons, such as these:

1. Sleep position. For the first several weeks of their life, babies are asleep on their backs, which means the backs of their heads are in the same position for a long time, making it flat. Being placed in ‘tight’ spaces like car seats, strollers, bouncy seats or carriers can also make it worse.

2. Prematurity. Premature babies are more vulnerable since their skulls are softer than those of full-term babies. Besides, they also spend an extended period on their backs in the NICU which contributes to a flatter head.

3. Forceps or vacuum delivery. The use of instruments like forceps or a vacuum to pull out a baby puts added pressure on the baby’s head, which could lead to a deformity in the skull bones.

4. Being one of multiples. When the mother carries multiple babies in her womb, there is less space in the uterus. This means that the babies’ skulls are more likely to be compressed leading to a flat head.

5. Breech position. Being in a breech position in utero can make it hard for the baby to move their head sufficiently, which can cause limited mobility in the neck and positional deformities in the skull.

6. Muscular torticollis. This is medical condition that causes tight or imbalanced neck muscles, which in turn makes it difficult for babies to turn their heads. This keeps them in the same position for longer, leading to a flat head on one side.

7. Gender and birth order. Studies have found that being the firstborn child or a male increases the chances of having flat head syndrome.

Congenital Plagiocephaly

Congenital plagiocephaly, also known as craniosynostosis, is a birth defect. It is quite rare, affecting only one in every 2000-2500 births. Here, the fibrous spaces between the baby’s skull bones fuse prematurely, resulting in a deformed skull shape. The exact reason for this is unknown, but it could possibly be an inherited disorder.

Home Remedies for Flat Head in Babies

1. Cut down on the time your child spends on her back, when awake. Avoid ‘containers’ that prevent your child from moving their head in all directions, like strollers, bouncy seats, carriers, car seats and others.

2. When your baby is in the crib, don’t use wedges or pillows to keep them in a particular position so they have freedom of movement.

3. Practice tummy time by letting your child spend more time on their tummy while awake. About 10 to 15 minutes,  3 times a day is fine, as long as it’s under adult supervision. This takes pressure off the back and sides of the head while also strengthening neck muscles.

4. Change positions during the day. For example, if you tend to feed or hold the baby on the right side, switch to the left. If the baby tends to sleep with one cheek against the mattress, turn her to the other side. Alternate the end of the crib when putting the baby down to sleep, and also switch around her toys so she’s encouraged to turn her head.

5. Hold your baby in an upright position so they spend less time with their head flat against a surface. You can also let your baby lie down on your chest to reduce flat head and increase bonding.

Treatment for Flat Head in Babies

While flat head isn’t a serious medical condition and can usually be dealt with through home remedies. However, in some cases, the flat head may be too severe, or the home remedies may not be working, which is when you need to see a doctor.

Doctors can diagnose a flat head simply by examining the baby’s head and neck movement, and other medical tests are generally not necessary. Based on the kind of flat head and the cause, they may prescribe any of these treatment options.

1. Molding Helmet Therapy. This involves placing a custom helmet on the baby’s head. This helmet is usually loose near the flat area and tighter in the remaining parts. Consistent wearing of the helmet helps the skull get back into a normal, rounded shape. Helmet therapy is recommended for babies between 3-6 months and takes about 12 weeks.

2. Physical Therapy. This is suggested for babies whose flat head is due to torticollis, where the neck muscles are stiff. The therapist will show how to stretch the baby’s muscles gently, so the muscles lengthen and loosen up, enabling the neck to move more so the flat head can disappear.

3. Surgery. Surgery is only required in extreme cases, like congenital plagiocephaly, since there is no other way to fix the sutures that have fused together prematurely. Surgery relieves pressure in the skull, enabling the brain to develop normally. Delaying this surgery could lead to complications like developmental delays or seizures.

Do’s and Don’ts for Flat Head in Babies

Do:

1. Watch out for flat head in your baby by observing her carefully, preferably after a bath when her hair is wet. The back of the head should be rounded evenly. the ears, forehead and the nose should be aligned. Frequent checks will help you notice anything abnormal.

2. Start fixing it as early as you can. Your baby’s skull bones are soft and pliable in the beginning but they harden over time. This means that most fixes work best before reaching 4 months of age.

3. Maintain a safe area for your baby to enjoy tummy time and for exploration.

Don’t:

1. Put babies to sleep on their backs – it can lead to SIDS – sudden infant death syndrome. The fear of flat head isn’t a good enough reason for that.

2. Use head-shaping pillows. These haven’t been proven to work, and they can also create an unsafe environment due to a suffocation risk.

3. Try any stretching exercises on your own. Never stretch your baby’s neck muscles without expert supervision or your doctor’s advice.

While flat head is harmless, be sure to go to the doctor if you notice any of these:

• Multiple flat spots around the head
• A slanting on one side of the head
• A misalignment of the eyes and ears
• Hard bony ridges on the head
• A missing soft spot

There’s no need to worry about flat head syndrome too much since it’s something that usually resolves easily as babies grow and change positions frequently. As your child’s hair grows, any remaining flat areas will get completely hidden, and no one will notice it anymore. As long as you include enough tummy time, constantly change positions and stay alert, you’ll find that it soon goes away on its own.

References:

• National Health Services UK (NHS)
• American Academy of Pediatrics (AAP)
• Stanford Medicine Children’s Health