Tag Archives: Brachycephaly

Read the latest posts on Brachcephaly from TiM, the UK’s leading clinic specialising in the treatment of flat head syndrome in babies

Flat Head Syndrome Pillow Advice

Should babies sleep on pillows?

Since the implementation of the Sudden Infant Death Syndrome (SIDS) campaign, there appears to have been an increase in the number of flat head syndrome cases. As a result, there are now many questions on the web surrounding what the best flat head syndrome pillow is.

Unfortunately, the solution is not so simple. This is because although there are currently pillows available that have been designed to reduce the tendency for a baby’s head to develop a flattened area, we do not encourage placing anything, such as a flat head syndrome pillow bumpers, or toys in a baby’s crib whilst they sleep.

We appreciate that the conflicting advice and products that are available can overwhelm parents, but our safety advice is always to sleep babies on their backs, on a flat firm surface: pillows contravene this safety advice and we don’t recommend pillows for babies under the age of one.

The main reason for this is that, should your baby get their face pressed against any of the objects, they will not be able to lift themselves up. Furthermore, once a baby reaches five months they begin to roll independently, making pillows even less useful.

There is however, still the concern that placing your baby to sleep on a flat surface can have a negative impact on their soft skull. So, what is the solution?

repositioningAt Technology in Motion, we always recommend giving your baby time on their tummy when they are awake and you are with them rather than resorting to the use of other methods. The introduction of repositioning techniques will allow your baby to spend time on their tummy, under your supervision, giving them time throughout the day without any pressure placed against their head. If you do have a donut shaped pillow, we recommend that you only use it to support the back of your baby’s head when your baby is awake and you are with them.

The preferred age for repositioning is as soon as you start to notice a flattening and even from birth. Repositioning becomes less effective between the ages of four and five months when your baby should be starting to roll independently, however, if a flattening has already started to develop you should begin repositioning immediately. Feeding your baby from different sides and changing their sleeping position in their cot can also help, particularly if they always tend to turn to one side.

Giving your baby supervised time on their tummy is also an ideal way to teach them to use their arms to prop themselves up and good exercise for strengthening their backs, hips and neck muscles. You can read more about the various techniques you can use on our Repositioning Guide and why they are more effective than using a flat head syndrome pillow.

Baby Flat Head Syndrome Concerns – Coby’s Plagiocephaly Story

Plagiocephaly or Brachycephaly, also commonly known as baby flat head syndrome and the use of corrective helmets has sparked many debates over the past few weeks. Although some babies who develop the condition in their early months have some improvement at the early stage using various repositioning techniques, other more severe cases can benefit from further medical treatment.

One mother who has recently experienced the condition firsthand is Andria Donnison, whose son Coby was born with Plagiocephaly. She first voiced her concerns to her health visitor when Coby was between 2-3 months, but was assured that it would correct itself once he started rolling over.

Due to her daughter’s concerns it was Andria’s mother, Carol, who sought further advice and came across Technology in Motion, a company which has been providing plagiocephaly treatment since 2003. Technology in Motion found Coby’s condition to measure within the severe range and recommended that they begin treatment in the form of a TiMband Plagiocephaly helmet. As the condition is still widely considered to be cosmetic, the helmets are not available on the NHS and cost the family  £1,950.

Andria said, “At first I was upset and also worried about the costs involved, but thanks to the support of our family, friends and the local community we managed to raise enough money for Coby’s helmet and awareness about the condition at the same time. I’m often approached by other mothers in a similar position who have also been told that their baby’s head will correct itself but have found otherwise. Having had such a positive experience with Technology in Motion I always recommend that they get a second opinion, even if it’s just for peace of mind.”

The local businesses in Bridlington came together, donating funds and items to raffle for the family to help raise the funds for Coby. He has since become quite the local celebrity, constantly recognised with his blue helmet and big smile.

At 11 months old, Coby has now finished his treatment, leaving the family doubting whether his head would have ever corrected itself had they left it.

Sandie Waddell, Coby’s Orthotist said, “Coby’s head shape had a very severe deformity before we started treatment and now you can’t even tell that there had been a problem. We know how difficult it is for the parents who come to see us but we also know what we can do for these little ones. Coby was 5 months old when they started treatment and 11 months old at the end of treatment. He started with an asymmetry of 17mm which improved to 4mm and a CI (width / length ratio) of 97% which improved to 87%. I am delighted with the result of his treatment and wish him and his family well for the future.”

Coby’s before and after head shapes are shown below.



National Childbirth Trust Advice on Plagiocephaly and Brachycephaly

The National Childbirth Trust has just issued advice on plagiocephaly and brachycephaly.
Technology in Motion endorses the advice given and recognises that milder cases will self resolve adequately, however the majority of the infants that we see have very severe head shape deformities which will never self correct, nor will hair cover the plagiocephaly adequately without intervention.
The full text can be found at: http://www.nct.org.uk/parenting/what-flat-head-syndrome-plagiocephaly-or-brachycephalys and here are the opening paragraphs of the advice.
What is flat head syndrome (plagiocephaly or brachycephaly)?
This article looks at ‘flat head syndrome’ outlining symptoms, possible causes and treatment.

Flat head syndrome is the name given to the condition when part of a baby’s head becomes flattened due to continued pressure on one spot. There are two types of flat head syndromes in babies.

  • Plagiocephaly – This is a flattening on one side of a baby’s head. Its most common form is ‘positional plagiocephaly’, which happens when a baby’s head develops a flat area due to continued pressure on one side of their head. Babies are most vulnerable because their skull is soft and pliable when they’re born.
  • Brachycephaly – This refers to the condition where a baby’s head is disproportionately wide compared to its depth. It can happen when babies lie for long periods on their backs. This causes the whole of the back of their head to flatten, resulting in a much wider and shorter head. Brachycephaly is less common.

Surveys show the proportion of babies affected by positional plagiocephaly ranges from 16% at six weeks, 20% at four months7% at 12 months to 3% at 24 months.

Why are some babies affected?

Babies’ skulls are made up of several plates of bone which are loosely held together. As they grow older the bones will gradually join. However, during birth and for the first few months their skulls are very soft and their shape can be changed by gentle pressure. In some babies continued pressure on one area of the skull may lead to some form of flat head syndrome.


  • Flat area on back or one side of the head.
  • Bulging on one side of the head.
  • One ear more forward than the other.
  • Unbalanced look to the face.

    Possible causes

    It is thought that  there has been an increase in babies with flat head syndrome following the successful ‘Back to sleep’ campaign, which advises laying babies on their backs to sleep. Research studies do not bear this out but there is certainly more awareness of the condition.

    The number of babies who have died due to Sudden Infant Death Syndrome(SIDS) has halved as a result of this campaign. However, laying babies on their back to sleep, combined with the use of baby equipment which has babies leaning back onto their heads for periods of time, such as car seats and bouncers, can lead to babies spending more time on their backs than ever before. It must be stressed that the benefits of laying your baby on his back to sleep far outweigh the risks of flat head syndrome (see articles on ‘Your baby’s sleep‘).

    Babies who have their head turned one way most of the time, perhaps because of an uncomfortable neck are more likely to develop a flattened head.

    Other possible causes could include:

    • Sometimes a baby’s skull may be moulded whilst in the womb. There may not be enough amniotic fluid to cushion the baby, which means his head can become temporarily deformed as he travels down the birth canal. Also, this can happen as part of a multiple birth as the babies become squashed within the womb. This sort of moulding tends to correct itself without treatment.
    • Premature babies are more likely to have an unusual head shape at first because their skulls are less developed.
    • Muscular problems – sometimes a baby will have tightened muscles in their neck (torticollis), which prevents them from turning their head one way and means they will always rest their head on the other side, causing this to flatten.
    • Craniosynostosis – rarely a flattened skull can come about by the bone plates within the baby’s skull joining together too soon. This can pull the baby’s head out of shape and will need to be corrected with surgery, so its worth checking with your GP if you are concerned about the shape of your baby’s head.

      Are some babies more at risk than others?

      This condition shows up most often in babies who:

      • are first born
      • have unusually large heads
      • are premature, twins or multiple births
      • have had an assisted birth (forceps or ventouse)
      • have limited ability to turn their head or torticollis (tight or shortened muscle on one side of the neck, causing the chin to tilt to the other side).

      There are other factors which are open to change including:

      • Caring for the baby on one side all the time
      • Not enough  ‘tummy time’ or carrying where there is no pressure on the head
      • Baby’s preference for turning their head to one side.

        What can be done to help?

        Doctors recommend that your baby is not left on his back for too long or too often, as this can create pressure on the same areas of his head.

        Plagiocephaly Self Assessment App.

        We see many parents who have been told that their baby’s plagiocephaly is mild but when we take objective measurements at an assessment, we find that there is often quite a severe deformity which is very unlikely to correct without some help. So, to help parents to make an informed decision, over the last year our web designers have been working hard on a new and unique Plagiocephaly Self Assessment Application tool to help parents to decide just how severe their baby’s plagiocephaly is.
        The application his is based on our plagiocephaly severity chart. This has also been developed over the last year and is based on our experience and understanding of the different nature of brachycephaly and plagiocephaly.
        To inform parents, the application shows the before and after head shapes for a group of infants who we have treated. Each one has achieved an outstanding result and we have included before and after images. Sadly, we can’t bring the more extreme head shapes back to full normality as we have to start with the shape that we are given, but we know that we can and do make a huge change to these infant’s head shapes which definitely would not happen without our help.
        The application works best with Google Chrome, Windows Explorer 9 and above, Firefox, Mozilla, Safari and Opera which are all able to manage the high graphic aspects of the Application.

        Successful Flat Head Helmet Treatment for Alice

        Alice Completes TiMBand Treatment

        Alice graduated today from her TiMband treatment

        We’d like to share Alice’s Plagioocephaly and Bracycephaly story with you. Alice’s Mum and Dad, Leanne and Craig brought her to see us when she was 5 months of age and they were worried that Alice’s head shape was ‘not right’ and wanted our opinion to see if we could help her. They’d tried repositioning but her head shape wasn’t improving at all.Looking down on the top, a normal head shape should look a bit like an egg with the length front to back being longer than the width. The normal head width is about 4/5 of the length and Alice’s head was much wider than this with the width being 99%, just 1mm narrower than it was long. A wide head shape is called a brachycephaly. Alice also had a difference across the diagonal measurements of 25mm which is quite a severe plagiocephaly.Leanne and Craig decided to ask us to treat her with a TiMband and Alice was discharged today after wearing the helmet for 5 months. She’s had a great result with both the width and the asymmetry coming into the normal range. The asymmetry is now 4mm and the width in relation to the length is 83%.

        Here are her before and after scans which show a really nice result and great improvement in symmetry in the face and at the back of the head.

        Mum is delighted and cannot believe how amazing Alice’s head looks now.

        Well done Alice!!

        What Causes Flat Head Syndrome in Babies?

        What Causes a Flat Head?

        Flat head syndrome is a condition that can appear at any time from birth, but it tends to take a few weeks or months to become apparent. Sometimes parents or health professionals notice that their baby’s head seems to have an altered shape with part of it appearing to be flat. If the flattening is severe enough, there can be asymmetry in the face and forehead with and one ear further forward than the other. There are a number of medical terms for this, including plagiocephaly, brachycephaly or scaphocephaly. Here we will discuss what causes flat head in babies.

        There are many different issues that can cause a flat head in babies, but they all stem from the fact that babies are born with soft skulls. Before a baby is born, the bone structure is not firm, but has to be soft and flexible to allow the head to descend through the birth canal. The bone plates in the head are not fused, but are held together with cranial sutures, which are essentially elastic tissues which need to be flexible to allow the brain to grow. Because the bones don’t fuse until the baby is a toddler, it means that the shape of the baby’s skull can be affected by a number of factors.

        For example, the way that babies lay in the womb can affect their skull shape. This is especially the case with multiple births where there is less room for babies to move around. It is the same for babies when there is not much amniotic fluid in the womb. Because the skull strengthens considerably in the last few weeks of pregnancy as mineralisation occurs, premature babies tend to have much softer skulls which are more prone to becoming misshapen.

        However, flat head syndrome most commonly occurs because of the baby’s sleeping position. This can be due to the very good advice to put babies to sleep on their backs or it can be due to a tight neck muscle on one side, called torticollis. The excellent ‘Back to Sleep’ advice has radically reduced instances of cot death. However, if the baby is positioned on their back for too long either in a cot, on the floor or on a firm baby carrier can result in the development of flat head syndrome. In mild cases, this will probably correct without clinical intervention and up to the age of four months it’s best to treat all babies simply through repositioning techniques. For example, babies can be encouraged to move their head by relocating mobiles and toys.

        During the day when they are awake and parents are with them, it’s a good idea to place babies on their tummy which relieves pressure on the affected flattened part. Tummy time is a great form of exercise for your child and allows them to develop muscles in the hips and spinal extensors.

        If you don’t see an improvement in your baby’s head shape after a month, it is best to seek advice from a medical professional who can suggest other possible interventions. These can include physiotherapy to increase the range of movement through to specialised bespoke helmets which will use normal growth to gently reshape the skull.

        These helmets gently help the skull reform into the correct shape as the baby’s head continues to grow and fuse. The helmets are custom-made so that they fit each child perfectly and they are lined with soft foam to keep the babies comfortable. Babies are also reviewed regularly to ensure that they are responding properly to treatment.

        In many cases, flat head syndrome can be corrected by repositioning, but more severe cases may need further intervention. It is important to realise that babies’ the growth needed to bring about correction is minimal when they reach about eighteen months, so it’s important not to delay seeking advice.

        Plagiocephaly Infographic

        Parents often ask us what can be done to minimise plagiocephaly. So to help and to use as an education tool, we have produced a Plagiocephaly Infographic to explain how plagiocephaly develops and what should be done to minimise and treat the condition. We are sure that parents and clinicians will find it useful.

        Plagiocephaly Infographic Childers Head Shape & Size Technology In Motion TiM

        How to Treat Baby Flat Head

        The Treatment for Flat Head Syndrome or Plagiocephaly

        Plagiocephaly, commonly known as flat head syndrome, is the medical term for a condition that affects as many as two out of every ten babies. Flat head syndrome develops when a baby repeatedly lies in the same position. This can occur when parents aren’t aware that they need to change an infant’s position during the day or because of problems with neck muscles. An infant’s skull is so soft that flat surfaces can actually mould the shape of an infant’s head. Since 1992 when the American Paediatric Society began recommending that infants sleep on their backs to prevent SIDS (Sudden Infant Death Syndrome), paediatricians have seen a six-fold increase in flat head syndrome. This experience is reflected in the UK since this advice was adopted. Babies must always be placed on their backs to sleep and this has saved thousands of lives. During the day when they’re awake and Mum is with them, babies should be placed on their tummies and pressure relieved from the back of the head.

        Plagiocephaly may be associated with brachycephaly, a type of flat head syndrome where the head shape is very wide and the flattening appears across the back of the head. With brachycephaly, the back of an infant’s head flattens uniformly, causing the crown to be wider and taller while the distance between temples and chin may be longer. Brachycephaly is also classified as flat head syndrome, and responds to many of the same interventions.

        Parents are usually the first to be aware of flat head syndrome. They may notice a flat spot on the back or side of their infant’s head where hair growth is noticeably sparser. Their baby’s ears may not be symmetrically aligned or some other facial asymmetry may be present. When torticollis, a tight neck muscle is a factor, a baby’s head may appear to be tilted to one side the much of the time.

        In the vast majority of cases, plagiocephaly caused by a restrictive sleeping position responds to simple therapies. Yet the diagnosis itself can be so intimidating that some parents may be frightened of interacting with their babies in a normal way that includes tummy time and playing to relieve pressure on the flat spot. A baby with a flat head is no more fragile than any other baby.

        Repositioning techniques are the best intervention for simple flat head syndrome. You’ll want to position your baby in his or her crib so that the affected side is not lying flat. When your baby is lying down, encourage active turning of the head by hanging a mobile or some other bright object where the baby will want to look at it. Limit the time your child spends in car seats, carriers and pushchairs with flat backboards that press up against his or her head. When holding, feeding, or carrying your baby make sure to reposition so that the flat spot is not pressing against you. Slings and other baby carriers which position your baby’s face towards your body benefit a baby with a flat head by decreasing the amount of time spent with pressure to the back of the head.

        Some parents misinterpret the Foundation for Sudden Infant Death (FSID) guidelines to mean a baby should never be placed on the tummy. This is simply not the case. Supervised tummy time is good for your baby. Tummy time helps babies develop control of their head and neck muscles and overall hip and spine development, it also encourages bonding, particularly if you are comfortable enough to get down and interact. Try putting your baby’s rattle and toys just out of reach so he or she is encouraged to reach for them.

        More severe cases of flat head syndrome may require physiotherapy and/or a corrective helmet. If your interventions don’t seem to be working, research the alternatives which will be able to help.

        What is Plagiocephaly and Brachycephaly or Flat Head Syndrome?

        What is Plagiocephaly and Brachycephaly or Flat Head Syndrome?

        What is Plagiocephaly and Brachycephaly or Flat Head Syndrome, are the most frequently asked questions Orthotists are asked. Plagiocephaly is the word that is used to describe a diagonal asymmetry across the head shape. This word particularly describes a flattening which is to one side at the back of the head and there is often some facial asymmetry. Brachycephaly describes a very wide head shape with a flattening across the whole back of the head. We usually see babies who have a combination of these two problems.

        Brachycephaly & Plagiocephaly

        Symmetric brachycephaly before treatment

        Parents usually notice that their baby has an irregular shaped head at about 8 weeks old and are usually told that it will correct itself naturally and that it is just cosmetic.
        Our advice is that as soon as flattening is noticed, then a parent should immediately start to reposition their baby. You can find information on this on our repositioning guide. This can assist in preventing the condition worsening and hopefully start to see improvement starting. If natural improvement of the plagiocephaly available it will happen in these first early few weeks of life. For an infant under four months of age we recommend repositioning.

        Will my baby’s plagiocephaly self correct?

        Our experience is that if the plagiocephaly or brachycephaly is not improving on its own by five months of age then it probably won’t improve greatly without some assistance. The treatment that we use to correct flat head syndrome is a PlagioCare treatment which rapidly accelerates return to a normal head shape. Treatment time for plagiocephaly depends on a baby’s age and takes between three to six months. The image below shows before and after images in a typical case of plagiocephaly with a brachycephaly. This little boy achieved this result after only nine weeks of treatment.
        Since 2003 Technology in Motion has been providing treatment for plagiocephaly and brachycephaly, conditions which describe a head shape deformation. We usually have over 100 infants in treatment at any one time and we are widely regarded as the leading clinical team managing flat head syndrome.

        What Is Flat Head Syndrome?

        Understanding Flat Head Syndrome

        Flat Head Syndrome is a general term applied to infants whose cranial development results in a flat area on the back or side of the head (deformational asymmetry). The deformation may be present at birth, or may become apparent during the first few months of the infant’s life. The two most common forms of the syndrome are plagiocephaly and brachycephaly. The term plagiocephaly is used to describe a flattening at the side of the head in the parietal region, above and behind the ear. Facial asymmetry may be noticeable on the forehead and there may be misalignment of the eyes and ears. When the flattening extends across the back of the head and the head is wider than usual, in this event the length to width ratio (cranial index) is outside of the normal, this head shape is known as brachycephaly. It is quite usual to see a combination of brachycephaly and plagiocephaly, showing as a wide, asymmetric head shape.

        Causes of Flat Head Syndrome

        Cranial birth deformities can be the result of intrauterine restriction which can be caused by several different factors. Positional moulding in the uterus (in utero moulding) occurs due to the inhibited position of the baby in the womb. It is more frequently seen in multiple births due to the restricted positioning of the babies and their heads. In other cases deformities of the head present at birth can be the result of birth injury caused by methods of assisted delivery (intrapartum moulding). There is also a greater incidence of plagiocephaly developing in infants born prematurely as their heads are much softer. Fortunately, the majority of these deformities caused both in the uterus or during birth improve naturally without need for treatment during the early months of the infant’s life. The exception occurs when for whatever reason when the infant is positioned in a way that exerts more pressure on one part on certain area of the head. In this case, the syndrome may worsen by simple gravitational force turning an initially minor plagiocephalic deformity into a potential long-term problem requiring treatment.

        Besides deformities present at birth, paediatricians have reported increases in the number of children with cranial deformities in recent years, particularly unilateral flattening of the occipital bone at the back of the head. This increase has been, at least statistically, compared with the significant decrease over those years in the numbers of cot deaths or SIDS (Sudden Infant Death Syndrome). The connection assumes that the increase in flat head syndrome can be attributed to parents following the positioning recommendations aimed at decreasing the risk of SIDS; specifically, the recommendation that healthy young infants should be placed down on their backs for sleep. The back to sleep advice has reduced Sudden Infant Death significantly and parents should always place their babies on their backs when sleeping. However, during the day when the infant is awake and the parents is with them they should spend at least half of their waking hours without pressure on the back of the skull to allow it to reshape naturally. If no improvement is beng seen by the age of five months then plagiocephaly treatment should be considered.

        Treatment of Flat Head Syndrome

        Initial treatment usually involves repositioning of the baby onto their tummy to reduce the pressure on the affected area, known as ‘Tummy Time’. This should be done for extended time periods during the day. In addition, repositioning cots and other areas in which the infant spends their day will force them to look in different directions to see parents or other areas of interest around them. It should be noted if the infant cries or appears to have discomfort when they are repositioned as this may indicate a problem with neck pain and this possibility should be addressed as tightening of the neck muscles can be common in infants. This treatment should continue until the age of 5-6 months.
        If the problem remains unimproved, parents should consider treatment of flat head syndrome with a helmet for a child while still less than 14 months of age. The ideal time to begin treatment is 4 to 7 months but correction can be gained from starting treatment up to 14 months of age. A cranial remoulding helmet (orthosis) can be designed that provides painless contact over the prominent areas of the skull while leaving protected voids to provide a pathway for growth by the affected areas for more symmetrical skull growth.