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How To Prevent Flat Head Syndrome / Plagiocephaly

Plagiocephaly or commonly called, “flat head syndrome”, is a condition where the head is asymmetrical and flattened on one side more than the other. Studies show 20-50% of infants aged 7-12 weeks had plagiocephaly. This is common! So what can we do to prevent it and why should we even care?

What Causes It?

  • Baby has an underlying condition such as torticollis or birth injury causing the baby to not be able to adequately and independently move the head appropriately

  • Baby’s movement is restricted by baby holding devices

Most babies are born with small muscle imbalances from being all squished in the womb. One side of the neck might be a little tighter than the other (torticollis) or one side of the torso slightly curved. Injuries may have occurred during birth, such as with forceps, that can cause muscle imbalances, and the over use of baby holding devices have been shown to lead to an increased incidence of plagiocephaly and decreased motor development.

Infants with plagiocephaly are often not initiating adequate, independent head movement, and when they are not given the appropriate opportunities to “stretch” themselves out, it can result in further muscle shortening and issues such as plagiocephaly.

Most parents worry about how flat head syndrome it looks, but the issue runs deeper. Not addressing an underlying muscle imbalance and overuse of baby holding equipment prevents the development of many systems. The baby’s sensory and integrative systems are on fire the first couple of months. Their eyes are learning to focus near/far, and their muscles are yearning to strengthen and stretch. All this is hindered when restricted by baby positioning devices.*

How To Check:

  • Look from the top down and observe if there is any flattening of the back of the head.

  • Are the ears lined up evenly, or is one higher/lower than the other? One forward of the other?

  • Is the forehead more prominent on one side?

  • Is one eye larger than the other?

  • Are the cheeks equal size?

Why It Matters:

  • Increased risk of neck tightening

  • Decreased sensory exploration and development that may result in sensory processing issues.

  • Slowed motor development

The shape of your baby’s head matters because it tells us a lot about the child’s movement. The underlying causes of decreased movement need to be addressed and should initiate a conversation with a health professional.

The use of baby gear such as the rock and play/bouncy seats, baby swings, napping wedges, strollers and car seats create an increased risk of head flattening, increased risk of neck tightening, decreased sensory exploration and development and slowed motor development.*

How To Pre

  • Tummy time- on you, on the floor, on the dog…anywhere! Tummy time should ideally be done more often than baby wearing. While difficult for many infants, it's vital to sensory and motor development. If your little one is extremely uncomfortable in tummy time, or has reflux, doing tummy time on your tummy, over a yoga ball, or on an inclined mat is perfectly acceptable. If you need help with tummy time, consult your healthcare provider.

  • Sidelying position is important for development as well and is easily overlooked. Make sure you do both sides while laying on a mat/blanket. Look in the mirror with baby, read books, sing, and encourage use of the free arm and head movement while in sidelying.

  • Break up long stretches in a car seat, stroller or swing with baby wearing. Avoid carriers that do not provide adequate support of the hips! Hips should look like a "W" and baby should be chest to chest with you. Face baby out only once he/she can hold the head up without support: around 4-6 months of age. While facing out, again, make sure your carrier provides the much needed hip support that legs are not dangling and there's a nice "w" shape. There are some well known carriers that do not provide the support that is needed (Baby Bjorn I'm looking at you). I highly recommend the Ergo 360, Tula and Lillebaby. Sling carriers and wraps such as the Moby, Boba, Maya ring sling and the Wildbird ring sling are great options, but don't give the wearer full range of motion in both arms like the structured carriers do.

  • When you need to put baby down to do laundry, shower, etc, try a flat play yard/pack and play with toys, vs a reclined position device.

  • Baby should always sleep on a flat surface on the back.

  • Turn baby’s head while sleeping to the opposite side, if he/she favors one side while on the back.

  • Get an occupational therapy consult for play position, positional options, infant massage/myofacial massage and craniosacral therapy.

  • Use head positional items while baby is awake and supervised. Place one in the car seat, one on the diaper changing pad, one in the stroller and one in your bouncer/swing if you have one to help relieve pressure throughout the day in baby's environment. Here are a few top occupational therapist recommended supports:

Boppy Noggin Nest Head Support. Great for stroller and car seat use as it stays put well with the 3 and 5 point harness systems. The cut out design relieves pressure while keeping your baby's head safely cradled. The product is endorsed by many Pediatricians.

Babymoon Pod 4-in-1 Multipurpose Infant Pillow for Flat Head Prevention. Can also be used for tummy time, nursing, and travel. The pod cradles your baby’s head by distributing pressure to help develop a round head shape. It's adjustable for a variety of uses. Machine washable.

Babymoov Lovenest Baby Head Support. Created by well-known pediatrician, its patented design distributes pressure evenly over the skull while letting babies move their head freely. This creates a unique cocoon-like holding effect that effectively helps prevent postural plagiocephaly.

The Treatment:

  • Changes to the infant's environment, their play and activites.

  • Have a discussion with health care provider if you are concerned about torticollis/plagiocephaly and request a referral to an occupational therapist and/or orthotist for cranial remolding if necessary

Most like the wait and see approach, but by 4-5 months, treatment should be initiated, especially if cranial remolding (helmet therapy) is needed/recommended. Most minor newborn asymmetries can be treated with lots of opportunities for movement and play to stretch and strengthen out of the tight baby held womb position and usually resolve within a few months. It can, however take up to two years for the head to fully fill out.

*Abbott, AL & Bartlett, DJ (2001). Infant motor development and equipment use in the home. Childcare Health Development, 27 (3), 295-306. Movement and play unrestricted by baby gear is important for motor development

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