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Plagiocephaly: Why Some Babies Develop Flat Spots and What to Do About It BY LINDSEY JOHNSON, MS, MCHES
Plagiocephaly is the medical term to describe a flattened area on a baby’s skull. This condition is sometimes referred to by physicians as “Flat Head Syndrome” and may impact up to 46% of healthy infants, according to Boston Children’s Hospital.
Types Positional plagiocephaly is the most common form. This is typically a result of extended periods of pressure on one area of the skull. Congenital plagiocephaly, or craniosynostosis, is a birth defect where the skull bones fuse too early. As a result, the skull is unable to grow properly and may cause a misshapen head. Causes and Risk Factors Back sleeping, extended time in car seats, swings and bouncy seats can contribute to the formation of a flat spot. Muscular torticollis is tight muscles in the neck present at birth that limit the head’s range of motion. When the neck cannot fully pivot, the head remains in the same position. Premature infants may also be more likely to develop plagiocephaly. The skull bones are softer and many premature babies spend an extended period on their backs hooked up to respirators. Johns Hopkins Medicine reports that first-born children, males, and infants born with the assistance of birthing instruments
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Treatment The first line of defense for positional plagiocephaly is reducing the amount of time the baby spends lying down. Limiting time in devices such as car seats, bouncy seats and swings is one approach. Creating ample opportunities throughout the day for the baby to experience supervised “tummy time” will strengthen neck muscles and limit time spent resting on the head. Increasing time snuggling the baby upright to the chest will also help strengthen neck muscles. Repositioning therapy with intentional positioning of the head in a different direction can also help. Some parents change the direction the baby lies in the crib, creating alternate views of the door and window to encourage head movement in new directions. In the case of torticollis, the pediatrician may refer the infant for physical therapy to release the tension in the neck and increase neck strength. For moderate to severe cases, some specialists may recommend an orthotic helmet, specially designed to the dimensions of the baby’s head. The helmet includes a hard outer shell with a soft foam lining on the interior. According to the American Association of Neurological Surgeons (AANS), babies who begin orthotic treatment between ages 3-6 months will typically complete therapy within approximately 12 weeks. Infants born with craniosynostosis are at risk for increased pressure in the head and limited space for brain growth. Treatment may include an orthotic helmet or surgery to open skull sutures to allow room for normal brain growth. Plagiocephaly is a common occurrence in infants. While it may cause alarm among parents, most cases are not severe and are easily corrected with simple techniques. Consult your pediatrician if you have concerns about your infant’s head development.
Photos courtesy of Ashley Mudra.
History In 1992, the American Academy of Pediatrics (AAP) began recommending back sleeping in order to reduce the incidence of Sudden Infant Death Syndrome (SIDS). While this campaign has reduced infant mortality from SIDS, it has increased the incidence of plagiocephaly.
may also be at increased risk for plagiocephaly. Duke Health states that twin births may also be at higher risk.
