Everything you need to know about flat head syndrome in babies
Flat head syndrome is a general term applied to infants whose cranial development has resulted in a flat area on the back or side of the head (cranial asymmetry). The deformity may be present at birth or become apparent during the first few months of the infant’s life.
Types of flat head syndrome and their symptoms
The two most common forms of the syndrome are plagiocephaly and brachycephaly (see below, right). 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 apparent in the forehead region and the eyes and ears may also be misaligned.
When the flattening extends across the back and the head is wider than usual with a disproportionate length-to-width ratio (cranial index), this head shape is known as brachycephaly. It is quite usual to see a combination of brachycephaly and plagiocephaly, presenting as a wide, asymmetric head shape.
Causes of flat head syndrome
Cranial birth deformities can result from several different factors, often in combination.
Positional moulding may occur in the uterus (in-utero moulding) due to restricted space in the womb. This frequently occurs in multiple births or those requiring assisted delivery (intrapartum moulding). The incidence of plagiocephaly is higher in infants born prematurely as their heads tend to be softer and more prone to moulding.
The majority of such deformities improve naturally during the early months of an infant’s life without any need for treatment. The exception occurs when the infant is consistently positioned in a way that exerts pressure on one particular area of the head, turning a minor plagiocephalic deformity into a potential long-term problem requiring treatment.
Paediatricians have reported a sharp increase 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 is generally attributed to the Back to Sleep campaign, which has dramatically reduced the incidence of cot death or SIDS (Sudden Infant Death Syndrome) but also left many babies with permanent head shape deformities.
Parents should always place their babies on their backs when sleeping. However, during the day when the infant is awake and the parent 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 seen by the age of five months, plagiocephaly treatment may be worth considering.
Prevention and treatment of flat head syndrome
Initial treatment usually involves repositioning to reduce pressure on the affected area, including plenty of ‘Tummy Time’ during the day. At night, the cot, toys and other items of interest should be repositioned to encourage the infant to face in alternating directions. This treatment should be continued until the age of 5 – 6 months.
If the infant cries or appears to find repositioning very uncomfortable, this may indicate a tightening of the neck muscles (torticollis), which is especially common in infants with flat head syndrome. If you think your baby might have torticollis, visit your doctor or orthotist for a check-up.
If repositioning has failed to make a significant improvement by five to six months of age, a custom-made cranial helmet can be used to remould the skull into a more normal, symmetrical shape. This works by gently restricting growth in the prominent areas of the skull whilst leaving other areas with protected voids to provide a pathway for growth.
The ideal time to begin treatment is at four to seven months of age but limited correction can often be achieved at up to 14 months. At around this time, the baby starts to move around more independently and the bones in the skull begin to harden. No further correction can be achieved at this stage except through surgery, which is only carried out in very rare cases.
We are a leading UK orthotist and a specialist in cranial remoulding treatment. Our unique TiMband helmet offers an effective and pain-free correction and has been used to successfully treat thousands of babies to date. Browse our website for more information on flat head syndrome and the service that we provide.