What is Flat Head Syndrome?

“Flat Head Syndrome” is a term used to describe positional changes to a baby’s head shape. All babies are at risk for this condition, and yet many parents have not heard about it or don’t know what they can do about it!

When a baby is born, their skull is made up of 6 different bones which are connected to each other by fibrous sutures. Having multiple bones is helpful during the birthing process and also accommodates the rapid brain growth babies experience in the first year! These bones start to fuse together when baby is around 1 year old and fully fused by around 18 months into the solid skull we have as adults. However, this also means that if a baby spends a lot of time in one position with pressure on one part of their head, the bones can shift and grow into an abnormal shape.

But why do more and more babies seem to develop flat head syndrome? Similar to torticollis, this is mostly related to changes in our society and day to day life. The biggest change in recent decades is the introduction of “Back to Sleep” for safe sleep practices. Caregivers also have access to more container toys, which can be incredibly helpful, but can also contribute to repeated positioning. Additionally more families are on the go, with baby needing to spend more time in the carseat and stroller throughout the day.

The medical terms for flat head syndrome are Plagiocephaly, Brachycephaly, and Scaphocephaly.

What about “cone head”?

Most babies who are born vaginally have what is called caput succedaneum, or swelling that creates a cone head look. This is very normal and should go away in about 2 weeks.

What are the risk factors for flat head syndrome?

While any baby can develop flat head syndrome some of the factors I have seen that increase their risk include:

Prematurity
Prolonged hospitalization in the first 4 months of life for any reason
Low muscle tone/hypotonia
Delayed motor skill development
Excess container toy use
“Good sleepers”
Large for gestational age at birth or babies who grow rapidly in the first few months
Babies with torticollis (learn more about torticollis here)

(Most babies who have a round head shape at 4 months old and are starting to roll will no longer be at risk for flat head syndrome.)

Is Flat Head Syndrome just cosmetic?

That depends. For mild changes to the skull shape there is limited risk of medical issues. For moderate or severe changes the research is limited on long term issues but we do see delayed gross motor skills at elementary school age. Some of the other medical issues that may arise include altered development of the visual system, altered development of the vestibular system and long term balance deficits, increased ear infections, and torticollis. Even if the concerns are mainly cosmetic, there are important factors to consider. Even through the back of their head will ultimately be covered by hair, most babies with flat head syndrome also show changes in their face. Abnormal head shape or shifting of the ears can impact wearing glasses, hats, and helmets as they get older.

How can I prevent or minimize flat head syndrome?

The number one thing caregivers can do is avoid repeated positioning! This includes time during the day playing on their back, sides, and tummy. It includes time being held or in a baby carrier. When they spend short periods of time in a container toy like a bouncer chair or swing, rotate the container so baby looks different directions. And my top tip is to alternate baby’s position in their sleep space!

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To monitor your baby’s head shape use a bird eye view (after bath time if they have hair!) and look for a round shape with symmetrical ear placement. You can also look at them from a profile view and look for a round shape with clear distinction between the head and the neck. Check at least once per week!

When to seek support from a pediatric physical therapist:

You notice any changes to their head shape
You notice your baby tends to favor looking one direction or tilting their head one direction even when you encourage them to look other ways
Your baby struggles with playing in positions other then their back

I always recommend that if you have concerns about your baby’s head shape to seek support from a pediatric therapist or orthotist who can help you understand the severity and risk factors for your unique child! Another reason why I recommend support if you have concerns is to rule out a rare but more serious condition called Craniosynostosis where the sutures between the skull bones fuse too early and this requires timely medical treatment.

How is flat head syndrome treated?

Treatment depends on your baby’s age, the severity of the changes, other medical conditions or concerns your baby has, their motor development, and your comfort with home activities. Treatment usually includes a repositioning program to help your baby be comfortable in other positions, addressing torticollis or developmental delays, and in some cases a helmet is required to help the head grow into a round shape. If caregivers hope to avoid a helmet I strongly recommend seeking treatment as early as possible when you notice concerns!

Have any concerns about your baby’s head shape? Trying to avoid a helmet? Not sure if your baby needs support? Contact us today and schedule a free discovery call or evaluation so we can help your baby bloom!

References:

Collett BR, Kartin D, Wallace ER, Cunningham ML, Speltz ML. Motor Function in School-Aged Children With Positional Plagiocephaly or Brachycephaly. Pediatr Phys Ther. 2020 Apr;32(2):107-112. doi: 10.1097/PEP.0000000000000687. PMID: 32218071; PMCID: PMC10507734.

The information provided in this blog post is for educational purposes only and not intended to be medical advice. Consult a medical professional or healthcare provide for diagnosis and treatment.

What Every Parent Needs to Know About: Flat Head Syndrome