Pediatric Deformational Plagiocephaly

The skull flattens when a baby’s head stays in one position for long periods of time. Sometimes a baby is born with this flattening because of a tight space in the uterus. This may happen if you are having twins or other multiples. Other factors that may increase the risk for flat head syndrome include:

• Muscular torticollis. This is a problem that is present at birth (congenital). One or more of the neck muscles is extremely tight. So the baby’s head stays in the same position.
• Early birth (prematurity). The skull bones of premature babies are softer. And many premature babies spend a lot of time in the hospital on respirators with their heads in the same position.
• Back sleeping. Babies who sleep on their back or in a car seat without changing positions for long periods of time can develop flat heads. But to reduce the risk for SIDS (sudden infant death syndrome), babies should always sleep on their back until they are 1 year old.

Flat head syndrome (deformational plagiocephaly) is when a baby’s head develops a lasting flat spot. The flat spot may be either on one side of the head or on the back of the head. This happens when a baby sleeps in the same position most of the time or because of problems with the neck muscles.

This condition is different from craniosynostosis. In craniosynostosis, a baby’s skull bones fuse together before they are supposed to. In deformational plagiocephaly, the skull bones don't fuse.

A baby is more likely to have this condition if any of the following are true:

• They are the first-born child
• The baby is a boy
• The baby was born with the help of forceps or vacuum extraction
• The baby has torticollis

This problem may not be noticeable or present at birth. It may develop during the first few months of life. A flat spot may appear on either side or the back of the head as the baby grows.

Your baby’s healthcare provider will check your baby’s head from all positions. He or she will also feel your child's head, particularly along the suture lines. Your baby’s healthcare provider will also take measurements of your baby’s head to figure out how serious the condition is.

Treatment will depend on your baby’s symptoms, age and general health. It will also depend on how severe the condition is. Some babies don't need treatment. The condition may go away when the baby begins to sit up.

For other babies, treatment may include:

• Changing your baby’s sleep position by turning their head to the opposite side
• Having your baby spend time on their tummy (stomach) while awake and supervised

Your baby may need to wear a special band or helmet if the problem is moderate to severe and turning the baby’s head hasn't helped. Helmets are often made of an outer hard shell with a foam lining. Gentle pressure helps to reform the head. As the head grows, adjustments are made. Some studies have shown that helmets weren't helpful for moderate to severe skull deformation.

The average treatment with a helmet is often three to six months. This will depend on the age of the baby and the severity of the condition. Your baby's healthcare provider will need to check your child carefully and often. Helmets must be prescribed by a licensed healthcare provider with craniofacial experience.

As babies grow and develop, they will move and reposition themselves. This removes the pressure that may have caused the condition. But if the flat spot is moderate to severe, it may not get better on its own. If treatment is not started early enough, the head may continue to be uneven.

This condition has increased since the national Back to Sleep campaign began. This campaign was started to decrease deaths from SIDS. It has been very successful. It is important that young babies who can't roll over or move on their own not be placed on their belly to sleep. To help prevent a flat head:

• Let your baby have tummy time while you are watching. 
• Lessen the time your baby spends in car seats and baby carriers. 
• Hold your baby, giving the baby time to be upright. 

If you notice that your baby’s head is misshapen or you are worried about a flat spot, have your baby checked by their healthcare provider.