Types | Causes | Prevention | Complications | Treatment

Defining Flat Head Syndrome

Flat head syndrome presents itself as a head shape irregularity to the back or side of the head. Parents usually notice a flat head in babies at around eight weeks of age, when they notice that their baby’s head seems slightly wide, the ear is pushed forward on one side, or the brow is more prominent. The condition can cause the baby’s head to look asymmetrical or deformed, depending on the type of flat head syndrome the baby has. This is sometimes searched as ‘flat head baby’ but really is a baby who has flat head syndrome.

As a baby’s skull bones (sutures) don’t fully fuse until later in childhood, their bones are soft and therefore can change shape, particularly if they lie in the same position once they’re born. Or, for babies who descend early or remain in one position in the womb, any pressure put on the head can cause the head shape to be flattened in the place where these pressures are.

If you are thinking “my baby had a flat head” and are keen to find out more initial information on what flat head syndrome is, please read our informative blog post.

Types of Flat Head Syndrome

There are many different types of flat head syndrome, depending on where pressure has been placed, and the shape of the head as a result.

There are four main categories of flat head syndrome, below is a list along with a description of each so that parents can easily identify them:

You may well have thought “my baby’s head is flat on one side”, with plagiocephaly being the most common type of flat head syndrome. It is often described as flattening to the side and back of the head, making the head look asymmetric when looking down from above. Another notable characteristic parents may notice is that their baby’s ears may not be aligned and that the cheek and brow on the flattened side has been pushed forward.

We often get asked by parents “the back of my baby’s head is flat, what does this mean?”, and the majority of the time it means that their baby has a brachycephalic head shape. Brachycephaly is characterised commonly as a wide head shape that can be very flat across the back. Also, the head can be very high at the back, and the forehead can be very pronounced in some cases.

This is a long, thin head shape that is sometimes called Dolichocephaly (doll-ee-co-kef-alley). A notable characteristic parents may notice is that their baby’s ears may not be aligned.

This is a normal head shape, defined as a baby with a head width between 78-83% of the length, and with a diagonal symmetry of less than 6mm. Looking down on the top of the head, it can resemble an egg shape.

Typically, babies are brought to us with a combination of brachycephaly and plagiocephaly, but we sometimes see the combination of scaphocephaly and plagiocephaly too. This doesn’t mean that a baby has two types of flat head syndrome; it just describes the position of the flattening. Some researchers tend to mix these two different types of deformities, putting them together under one ‘flat head syndrome’ umbrella.

However, this can be problematic when it comes to treatment (to be discussed later) because if you are unsure where you are starting, it’s impossible to know exactly where to allow the head to grow later down the line. At Technology in Motion, we always quantify each head shape so that we know exactly where to allow the head to grow during treatment.

For more detailed information on the different types of flat head syndrome, please check out our article.

There are also head shape deformities and conditions that often get confused as types of flat head syndrome. Craniosynostosis is one rare condition we get asked about in our clinics. You can find out more information on craniosynostosis on our dedicated page.

What Causes Flat Head Syndrome?

So, what causes a baby to have a flat head? Well, there are a few flat head syndrome causes:

1. Lack of Tummy Time

As a way of balancing out the time spent on their backs when sleeping unsupervised, tummy time is a great way of ensuring that not all time is spent on their backs; be sure you are awake and watching your baby during this time. If tummy time isn’t used as a way of trying to even out the percentage of time on a baby’s front and back, flat head syndrome can develop.

2. Pressure in the Womb and During Birth

One of the main flat head syndrome causes is due to their being pressure applied to the baby’s head while in the womb. This is seen most commonly during multiple births, as there is less space and therefore a greater risk of pressure being applied to unborn babies soft heads.

Based on the idea of flat head syndrome developing due to pressure on the skull, if forceps or vacuum delivery is required when giving birth, these methods can sometimes cause flat head syndrome to occur too.

3. Premature Births

When babies are born prematurely, they tend to have softer bones and are therefore more susceptible to flat head syndrome occurring. In addition, as premature babies are often smaller and weaker, they may tend to rest their head over to one side initially, as they are unable to move their heads themselves.

4. Torticollis

Torticollis, known as “twisted neck”, is when a baby has stiffness in the neck and can affect a baby’s ability to turn its head fully in both directions and also cause a baby’s head to tilt to one side. As a result of the restricted movement and pressure on the same part of the head, this can cause flat head syndrome to develop.

5. Sleeping Position

Since the Back to Sleep Campaign emerged in the 1990s, babies are being put to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). This policy has saved the lives of many babies. Our advice is always to place your baby on their back to sleep, and then when they are awake, and you are with them, make sure that they work on tummy time and repositioning.

Preventing Flat Head Syndrome

There are numerous ways to prevent flat head syndrome from developing or to minimise the occurrence of flat head syndrome when your baby is young. Many health professionals will insist that flat head syndrome will correct itself somehow. However, it is worth bearing in mind that research shows that 1 in 25 infants of the population who have a severe form of flat head syndrome shape at two years old, will still have a severely deformed head shape at ages 3 and 4.

Tips to Prevent a Flat Head in Babies:

1. Repositioning

Parents normally start noticing a flat spot on their baby’s heads at around eight weeks old, as the bones are still malleable repositioning your baby at night and when awake during the day, can have a great effect on preventing the flatness from increasing in severity or even developing at all. Please read our repositioning guide, for advice on how to safely carry this out.

2. Plenty of Tummy Time

Just as a lack of tummy time can cause plagiocephaly, the best way to prevent it from occurring is ensuring that tummy time is a regular part of your baby’s routine in the day. We have a full tummy time guide, should you need further advice on this.

3. Simple Holding Alterations

The simplest changes during everyday day activities can help to prevent flat head syndrome, such as; limiting time in car seats and being mindful of baby’s feeding position, always ensuring they spend a limited time lying on their backs or with external pressure to the back of their heads when carrying out these daily activities.

4. Exercises for Torticollis

If your baby has torticollis, to ensure it doesn’t result in flat head syndrome developing, there are exercises you can do to loosen the tightness in the neck. Please ensure that you speak to a doctor or a specialist about these exercises before trying to do any yourself.

Complications

Flat head syndrome side effects tend to come to light when your child is slightly older. Practical difficulties such as not being able to wear standard sized sports helmets and headgear can have a psychological and social effect on many children. In addition, psychological concern and emotional distress can occur if a head shape is severe, particularly throughout school, and be carried into adult life. To find out more about the long terms effects of plagiocephaly, please read our previous article.

There is some evidence from research to suggest flat head syndrome is associated with developmental delays but you can not assume a cause and effect link, there is just an association. You can read one of these particular investigations and it’s findings here.

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Flat Head Syndrome Treatment

If you have tried repositioning and various other preventative measures as a form of flat head treatment, but the flatness is getting worse or hasn’t reduced, then flat head syndrome treatment in the form of a cranial remoulding helmet therapy can help.

Between the ages of 4 – 14 months cranial helmet therapy can be undertaken, which is what Technology in Motion specialises in. These helmets are custom-made to allow your baby’s head to grow and reduce the severity of the head deformity. At Technology in Motion, we have two types of helmet our TiMband and our TiMbandAir, both help to correct the positioning of the form of the head bones without any pain occurring, simply by giving the head the space it needs to develop into a more natural shape.

This flat head syndrome treatment can only be done up to 14 months of age; this is because, after this age, the bones in the child’s head are no longer pliable and will have joined together. You can view more about this form of flat head treatment and the relevant treatment timelines, on our dedicated page.

Is Flat Head Treatment Necessary?

You may be wondering if helmet therapy is needed to treat your baby’s flat head syndrome. Overall, moderate to mild cases of flat head syndrome will improve using the preventative techniques mentioned. However, severe cases are much less likely to be treated using these methods, and our advice is that if by five months of age, your baby’ head shape isn’t improving then it will need some help to get it on the way back to normal. This is especially true if a baby is on the older end of our recommended treatment timeline.

As the cut off for treatment is at 14 months of age, exploring the option of treatment while your baby is still young is recommended. Our experience is that the earlier you start, the better the result and the quicker the treatment.

We appreciate that the decision to go ahead with helmet therapy is not something that parents should take lightly. That’s why we offer no-obligation initial consultations at Technology in Motion to determine the severity of your baby’s head shape and give you a chance to discuss things with a clinician before making any decisions.

Should you wish to book an appointment with your local Technology in Motion clinic, then please call us on 0330 100 1800.