Expert / 4 April, 2017 / Anastasia Alcock

Will My Baby Get a Flat Head from Sleeping On Their Back?

To support World Plagiocephaly Day on April 4th, we asked resident expert Dr Anastasia Alcock to give us the low-down on the condition, what to do to help prevent it, and new research published. Also known as flat head syndrome, plagiocephaly affects 47% of babies and early detection is key in helping start repositioning a baby’s head to help treat the flat spot. ‘Flat head syndrome’ is a topic we’re emailed about fairly regularly, and one that can be quite alarming for new parents. 

Just recently there has been new interest in the management of ‘flat head syndrome’ or ‘moulding’ due to new research published in the British Medical Journal.  It showed that treatment with helmets is not any better than leaving alone and letting nature takes its course.

Babies can develop a flat head in the first few months of life.  This is because their skull is made up of different plates of bone that are mobile and relatively soft.  There are two main types of flat head:

• plagiocephaly: this is the most common type and occurs when one side of the head is flattened, this causes the head to look asymmetrical.  If you look at the head from above the ears can look out of alignment.
• brachycephaly: the back of the head is flattened.  The head is widened and the face can appear broader

The soft skull bones flatten due to pressure and once the head has become misshapen in this way, it is more likely that the head will lie in the same place each time, compounding the problem.  Causes of a flat head include:

1. • Lying on their back while asleep – this is the most common cause
   • Tightened neck muscles on one side, the baby can only turn their head a certain way – this can be corrected with physiotherapy
   • Craniosynostosis, a rare condition caused when two or more of the sections of the skull fuse together early and are unable to grow and develop normally, leading to an asymmetrical head – this is corrected with surgery.
   • Premature babies often have altered head shapes, as they may have spent many weeks lying on their back or side in an incubator. This corrects as they grow and spend more time in other positions.

Usually, the flattening of the skull is a mild, cosmetic issue and does not cause any problems with a baby’s development.  It usually resolves on its own.

There are some measures you can take to reduce the incidence of a flat head.

• Babies definitely need to sleep on their backs; this significantly reduces their risk of sudden infant death.  However when they are awake you can alter their position – they can be on their side as well as on their tummies.  Tummy time is great for their core strength and allows them to develop strength in their neck, back, shoulders and arms
• Alter their position so that they are not constantly putting pressure on the same area of the head.  You can also change the position of their mobile or toys to encourage them to look in a different direction
• They can spend time in your arms or baby carrier
• When they are older they can sit up supporting themselves

If your baby has already developed a flat head, it may take six to eight weeks of employing these practices for you to notice a change, so be patient.

The other treatment choice is using a helmet or skull band (cranial orthoses).  They have recently been shown not to be any more effective than positioning and leaving the bones to remodel with time.  Research was done by a team from the Netherlands who followed up 84 healthy babies with flat head syndrome (none of them with severe deformity).  They gave half the babies a custom-made helmet from between the age of six months and one year, whilst the other half had no treatment.  At two years of age the children were then reassessed, there was felt to be no significant difference between the two groups.  A quarter in each group made a full recovery (26% who wore the helmet for 23 hours a day for 6 months and 23% who had no treatment)

The helmets and skull bands are aimed to reduce pressure on the flattened area and to put pressure on areas of bone that bulge out. They are made of a rigid plastic with a foam lining.  Helmets or bands are used on babies between six to twelve months old, when the skull is growing at its fastest. The baby needs to wear the device for up to 23 hours per day for between six weeks and six months, and it must be resized every six weeks to allow for normal growth and to prevent sores. Helmets and bands can be uncomfortable and hot, especially in the summer months.  They can lead to sores, rashes, sweating and difficulty in giving cuddles due to the bulkiness of the helmet.  These helmets and skull bands are expensive (they are not available on the NHS).

I hope that this review shows you that there are a variety of things that you can do to help minimise the risk that your baby is going to get a flat head shape from sleeping on their back. It is absolutely vital that your baby is put to sleep on their back, however when they are awake they can be in a variety of different positions.  Some doctors feel that those babies who get flat heads move less than those babies who do not, ie they would have developed a flat head no matter what you might have tried to prevent it.  Most importantly the flat head shape usually corrects itself given time.

DR ANASTASIA ALCOCK

MRCPCH MBBS BSc(Hons) DTM&H DPID DRCOG