New Guidelines for Flat-Head Syndrome in Babies

A new report published this week in the journal Pediatrics contains new recommendations for pediatricians and parents on how to prevent and correct head flattening in babies.  The number of babies diagnosed with the misshapen skull syndrome known as positional plagiocephaly has increased exponentially since safe sleep recommendations have had infants spending so much time on their backs, researchers found.  And while they in no way suggest that parents ignore the recommended safe sleep practices, researchers suggest that pediatricians counsel parents from their babies’ very first checkups on ways to prevent and correct flattening heads.

CNN.com lists 5 of the recommendations, which can help parents avoid placing their babies in skull-correcting helmets if the problem has not improved by 6 months of age:

  • - Increase “tummy” time, which is supervised time during the day when baby lies on its stomach.  A baby should spend at least 30 to 60 minutes a day on it’s belly, something that can be done immediately after birth.  This will help develop neck and shoulder muscles, says [the report's lead author, Dr. James] Laughlin. It has also been shown to “enhance motor developmental scores,” according to this new report.
  • -  The NIH recommends changing the direction your baby lies in the crib each week.  They say this change will encourage the baby to turn his or her head in different directions to avoid resting in the same position all the time.
  • - Some babies prefer to hold their head to one side. Laughlin suggests laying them down in a different way when they’re awake, so they have something interesting to look at on the opposite side. If you have them in a car seat or sitting in something else, you can also change the position to make the baby look in the opposite direction.
  • - Parents may find their babies sleep well sitting in a car seat, but this is another way they can develop an asymmetrical shape, especially in the first 6 months of life.  So experts suggest babies shouldn’t spend a prolonged period of time in a car seat (unless they are in a car of course) or bouncy seat.
  • - Cuddle!  The NIH says “getting cuddle time with the baby by holding him or her upright over one shoulder often during the day,” is another way to prevent flat spots.

Image: Baby doing tummy time, via Shutterstock.

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  1. by lrm

    On December 15, 2011 at 9:55 am

    You neglected to mention that if a baby consistently holds or turns his/her head one way, they may have a condition called torticollis that may require physical therapy, and in the rare instance, surgery to correct.

    Further, if parents notice that their child’s head is flat or in any way misshapen, it is important to bring it to the doctor’s attention to rule out craniosynostosis, the premature fusing of skull sutures, which does require surgery to correct.

  2. by Jennifer

    On December 15, 2011 at 10:00 am

    My first girl I put to sleep on her back. She has a flattened head now.

    My second daughter, I put to sleep on her stomach. No flattened head.

    End of story, as far as I’m concerned.

  3. by s

    On December 15, 2011 at 10:01 am

    My son had torticollis and had physical therapy for a while. And we had to take him to a neurosurgeon to get a catscan of his head to rule out surgery.

  4. by Gabi

    On December 15, 2011 at 10:18 am

    I think it also depends on the cushioning of the bed. I would always lay my baby flat on his back and he never got a flat head. He slept with me the first 5 months and my bed is very soft. I’m also breastfeeding so his head would always be in a different position. He’s now 6 ½ months and he has a perfectly round head. He’s also sleeping in his crib now :)

  5. by Trish

    On December 15, 2011 at 10:19 am

    My little guy has torticolis to the extent that the dr had never seen it that bad in an infant so young (4 days old). It’s very difficult to just change positions in the carseat etc as mentioned since he is too young to hold his head up it just lays on his shoulder. Physical therapy is required hopefully nothing more but we see a specialist next week.

  6. by Christina

    On December 15, 2011 at 10:35 am

    My son absolutely hated to be on his tummy and would pitch a huge fit every single time I put him on his tummy. This made it hard for me to give him tummy time because he hated it so much and would get in a bunch of distress every time. He always wanted to lay his head a certain way, then he developed a flat spot on that side. I tried everything to get him to sleep differently, putting a blanket on the one side of his head so he couldn’t lean that ways, everything safe you could think of. Did not work. The back of his head was flat for some time, but then it started rounding out around 7 months old. He’s almost 10 months old now, and it’s not perfectly round, but it isn’t flat like it was. His dr hasn’t said anything about it, yet. This is interesting information and would have liked to of found this 10 months ago.

  7. by Lala

    On December 15, 2011 at 10:37 am

    I am so sorry to hear about the parents whose babies have unfortunately been diagnosed with positional plagiocephaly and torticollis, but as a early childhood educator it is important and potentially live saving to place your infant on their backs to sleep instead of on their stomachs.

    I again am truly saddened to hear about the diagnoses some babies have received as a result of back sleeping, but honestly – which one would you rather have? Your baby dying of SIDS or sleep related infant death or having a flattened head? At least the babies with flattened heads survive and are around to go to physical therapy and transcend their diagnoses.

    What about the parents whose babies died in their cribs and in their mother’s beds while sleeping on their stomachs? I am certain that those parents whose babies are dead would’ve much preferred their babies to be alive with flattened heads…

    Try to remember that – putting babies to sleep on their backs in a safe sleep environment (either a crib or a bassinet) is about SAVING INFANTS’ LIVES!

  8. by Jessica

    On December 15, 2011 at 10:41 am

    I just held my son as much I could and tummy time. He slept on his side too.. for some weird reason he just wouldn’t sleep on his back and would freak out.

  9. by Liz

    On December 15, 2011 at 11:09 am

    I have personal experience with Plagiocephaly. My son was diagnosed with this when he was 6 months old and had to wear a corrective helmet. We first noticed it at 3 months and the neurosurgeon disregarded it and didn’t do anything. So, we got a second opinion and that neurosurgeon recommended he wear one. Needless to say, we were 3 months behind the 8-ball. I strongly encourage parents to go with their gut and if they feel as though their child’s head is flat, please keep pushing it and pushing when their younger.

  10. by Traci

    On December 15, 2011 at 11:16 am

    It is very important to hold babies as often as possible instead of leaving them in car seats and bouncy seats. Too often we cary our babies around in “plastic buckets” (infant seats) instead of taking them out and physically holding them when we are at a resturant, store, ect. This simple change would not only improve head shape but would also allow the babies to improve neck control and interact socially with their environment. I know sometimes it is not practical to take them out of the seats at a store, especially if you have more than one child, but trying to find opportunities will improve the babies, physical and emotional development.

  11. by karen

    On December 15, 2011 at 11:18 am

    My son slept on his back and had a lot of tummy time but he still developed a flat spot on the right side of his head and had torticollis. We had several doctor trips, physical therapy twice a week, and a lot of changes with his sleeping position. we had to put a rolled up blanket on under a different side each time he went to bed to get the right side to fill out more. He almost could have had to have surgery but we were lucky. This was when he was 2 months old. He is now going to be this month and he still has a small flat spot on the right side close to the back of his head, you don’t see it though unless his hair is really short or wet.

    As much as I am glad that sleeping on his back helps protect him from SIDS, they need to find a way to get the percentage of kids with flat-head syndrome and torticollis down because those 2 things can cause future problems for children if it’s really bad. Everything mentioned above, I had been doing before the flat spot and it still happened. They need to find a way to protect kids from SIDS and protect them from flat spots and torticollis.

  12. by becca

    On December 15, 2011 at 11:25 am

    What about the parents whose babies died while sleeping on their backs? I dont really think they find much comfort in the fact that their baby died even though they were laid on their backs. No one knows what causes SIDS. It hasn’t been proven that laying on their back is a deterrent. If a baby can lift its head, or move it with ease, the chance of them dying of SIDS while laying on the stomach, is the same as laying on their back. My son is 4wks, and sleeps on his stomach. He sleeps much better. His face isnt going to somehow get stuck in his mattress to the point where he will suffocate. If a baby were having trouble breathing, or getting oxygen, they would move their head. Its a natural reflex, not a learned act. If they can lift and move with ease, I dont see any reason to keep them on their backs all the time.

  13. by jennifer

    On December 15, 2011 at 11:38 am

    Right on, Becca. I think the reports of SIDS due to sleeping on tummies is WAY over-reported. They don’t know what causes it. Back in the day the same docs said we MUST put them to sleep on their backs for fear of SIDS. My second daughter, who sleeps on her stomach, is SO far advanced when it comes to physical milestones than my first who slept on her back. It’s how babies are supposed to sleep.

  14. by Amy

    On December 15, 2011 at 12:22 pm

    My daughter favored turning her head to one side for the first several weeks. I took her to a family friend who is a chiropractor (a DO would be even better if they do OMM) and he did a very gentle adjustment on her neck because he said the tendons were tight on one side; no other problems since, and she was less fussy as well. Some helpful strategies to avoid flat-head syndrome: baby-wearing (with a good-quality sling or wrap like the MobyWrap that prevents hip dysplasia) there are many studies to back up the benefits, side-sleeping (you can purchase a little form with wedge shaped sides that helps baby stay in position if they like to roll) and the a fore-mentioned tummy time. I let my babies sleep on their tummies, sides and back, basically however they rolled and fell asleep. Most of them seemed to prefer sleeping on their sides though, for whatever reason. Keep in mind that the medical community comes out with new recommendations every few years, often contradictory to the last one. They are learning as they go too. The bottom line is use common sense and don’t place your infant in the same position all the time.

  15. by Julie

    On December 15, 2011 at 12:34 pm

    My husband and I noticed that our son had a flat spot on the right side of his head around 2 months. At our 3 month check-up we spoke with our pediatrician about it and she referred us to specialists to evaluate him for plagiocephaly and torticollis- he ended up having both. His plagiocephaly was so bad that he ended up needing a cranial helmet and weekly physical therapy appointments to help with his torticollis. He is now 9 months and his helmet has helped wonders but we’re still wearing it hoping his head will completely even out per the recommendation of our care team.

    I don’t see it mentioned in the article anywhere that positional plagiocephaly can also occur while the baby is in the uterus. Depending upon the position of the baby there and how long he/she is in the same spot, there can already be a predisposition regardless of what you do to try and minimize it. We think this is the case with our son; we tried re-positional therapy (as the article mentions) but it was very clear early on that what we were doing was not going to have a positive impact.

    For those parents who suspect your baby may have positional plagiocephaly and/or torticollis please do not wait until the 6th month like the article is suggesting as babies are in the midst of head growth during this time and you might lose out on this valuable window of time. The older a baby gets the more difficult it becomes to correct the condition so please speak to your doctor upon first suspicion and trust your gut- my husband and I just knew that our son would need the crainal helmet and that was the case for him. Wish us luck as we finish up with the last month of wearing the helmet!

  16. by dee

    On December 15, 2011 at 1:38 pm

    Everyone will give you recommendations to prevent flat head syndrome. I noticed my child had a flat head at weeks old. We did everything that was mentioned around the clock and it did not improve. He even would sleep on his tummy during the day. Our pediatrician starting monitoring him at his 2 month check up and referred us for a helmet at his 4 month check up. He ended up having to use a cranial helmet for 12 weeks starting at 5 months and his head improved drastically. So don’t get stressed out if you have tried everything and are not seeing improvements like we did. I feel that some babies are just born that way. Only problem is that the insurance usually does not cover the $4,000 cost of the helmet.

  17. by Laurel

    On December 15, 2011 at 5:12 pm

    My nine month old baby girl just got her helmet off. Her head looks great! However, I wish we were warned more about the flat head syndrome. We were greatly disappointed when we were told that she would have to wear a helmet. My mother was furious because she feels this back is best campaign has created a new industry. Anyone who has waited in the waiting room at one of these doctors for hours–yes, I said hours–knows what I’m talking about! I am currently pregnant with my second child and I am considering putting him/her on her tummy at bed time. My brothers and I slept on our tummies and we didn’t have cranial problems.

  18. by Megan

    On December 15, 2011 at 8:03 pm

    My daughter just turned 9 months old and SHE HAS ALWAYS SLEPT ON HER TUMMY. She has a beautiful round head, and has always hated sleeping on her back. Wouldn’t do it. The threat of a baby spitting up and choking while on their back seems more likely than getting their heads stuck. I am the youngest of 4, all of us slept on our tummies. My 7 year old slept on his tummy….you get the point. Use your own judgement, but I’m an advocate for the natural tummy position for babies. The medical community changes their ideas on “what’s safe” constantly, so just use your own discernment.

  19. by Olga

    On December 16, 2011 at 2:57 am

    Carry your baby in a soft baby carrier during the day, let them sleep on you and you avoid the flat-head syndrome plus you let your baby to reach his/her full potential!! It has been proven by many researches and studies that carried babies sleep better, cry less, gain more confidence, learn faster etc. Since they are in an up right position in the early weeks and a soft fabric plus your body support their head you can totally avoid the flat-head syndrome.

  20. by Jennifer

    On December 16, 2011 at 4:29 am

    Some of you have mentioned “positioners” that help keep the baby on their side and tummy sleeping – I work in a NICU with at-risk infants and there has been a 30% decrease in SIDS secondary to safe sleep practices, so please do not advise people on any other sleep position but back sleeping, it prevents infant death! The best advice I can give is to provide tummy time during the day, as often as possible so that your baby will grow to enjoy this position and also learn it is the perferred position for play time. There are also many instances when infants have flat heads secondary to their in-utero positioning, which causes most of the flattening in very young infants with plagiocephaly, so parents should not always blame the positioning that occurred after birth as a cause. If you are concerned with your infant’s head shape, talk to your pediatrician and if you do not get answers, then it is wise to seek out a physical or occupational therapist who can provide further recommendations and stretching exercises.

  21. by Andrea

    On December 16, 2011 at 9:51 am

    My oldest was a back sleeper and laid on her back much of the time (she was a late roller), but has a perfectly round head. My youngest was the same. My son on the other hand had fairly severe torticollis and refused to sleep flat on his back (I’m guessing because it was uncomfortable for him). He ended up sleeping in his car seat because it was the only way he would sleep. I’m sure this contributed to his plagiocephaly, but it’s the only way he’d sleep. He needed physical therapy and a cranial helmet to reshape his head. He’s now 8 and his head’s not perfect, but it is light years from where is was before treatment and I don’t think is noticed by anyone but us.

  22. by Scrapeboard

    On December 17, 2011 at 4:14 pm

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  23. by Heather

    On December 19, 2011 at 3:50 pm

    I have done all of these things since my son was born! He’s my first kiddo, and I was blessed with the opportunity to be a stay-at-home Mum for a little over a year.

    No matter what I tried, my little one always favored sleeping with his head to one side. I made sure he had tons of tummy time. I moved and changed his mobile, where and how he laid in his crib. I even tried a soft wedge, and a rolled up blanket. Little bug never stayed on them, he’d squirm, and still turn his head. As he is my first I held him all the time, switching his position, every little while. I breast and bottle fed. (My body couldn’t produce enough on it’s own.) I did every safe thing that I could think of.

    My little one still developed a flat side on the back, right side of his head. Because of this, it looks like he has a huge knob on the left. I brought it up to his pediatrician when little bug was 2-3 months old. I had noticed it, that it was worsening, and was concerned. My son’s ped. said it was normal, and that “his skull would eventually even out”. He is now 18 months, and both oddities are still present. Bug has a new ped. but when I first brought it up to her, she said “We’ll keep an eye on it. It’s normal for this to happen, their plates are still moving.” My little bug, has been advanced in almost all areas of development, so she saw no need for a specialist.

    I’m not a vain person by nature, however, it does still bother me. My bug’s pretty active. I know all kids fall and hit their heads. I’m just worried that he could get hurt worse, (because of the back of his head), if he falls backwards. This has become a larger concern, as he furthers his climbing experience, to higher places.

    Can anyone please give my advice, as to what I can do? Is there any way I can correct this? Do I even need to be concerned about it? Thank you!

  24. by franchise shop

    On December 20, 2011 at 6:43 pm

    but When i thought youd have something intriguing to state. All I hear can be a bunch of whining about something that you could fix if you werent too busy

  25. by Courtney

    On December 24, 2011 at 5:32 pm

    Easy fix. Carry your baby in your arms or in a sling, not in a car seat. Co-sleep with your baby. This flat head syndrome is a direct result of the way we parent in Western families. If a baby is physically developing abnormaly because of your parenting style, you are doing something wrong.

  26. by Debbie

    On December 28, 2011 at 8:33 am

    My girls never could sleep on their backs so I used wedges to have them sleep on their sides. I’d switch sides after each nighttime feeding. They used to spend time on their backs during the day or sitting in their swing. During the day, I would let them lay on their tummy with supervision, of course.

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  34. by Brittany

    On March 23, 2012 at 12:29 pm

    My daughter was diagnosed with torticollis and plagiocephaly. Her pediatrician reccomended physical therapy. I then brought to his attention the curve I had started to notice in her spine. Turns out, she didn’t need physical therapy: she had scoliosis! It isn’t a major angle, so as of now, a pediatric orthopedist is keeping an eye on it.

  35. by am

    On November 9, 2012 at 7:43 am

    my baby is six months old.His head is to much flat due to back sleep.nw what I,ve to do?

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