When my little one started sporting a flat spot on the left side of the back of his head, I started to worry. “What if it doesn’t go away?” I asked myself. I spoke to my pediatrician about it at his 2-month well-baby visit. His prescription? Tummy time — lots of it, as often as possible, except while sleeping.
While the “Back to Sleep” program has decreased the number of SIDS deaths significantly, positional plagiocephaly — otherwise known as “flat head syndrome” — in infants has been on the rise. But putting baby on his back during naptime and bedtime isn’t the only culprit (the American Academy of Pediatrics still recommends all infants be put to sleep on their backs). Prolonged time in car seats, baby swings and bouncy chairs are also to blame.
According to Eric H. Hubli, M.D., director of craniofacial and cleft services at Cook Children’s Medical Center, “The greatest risk of onset is in the first six months of life because this is when most babies spend a great amount of time on their back. At this time, the skull is pliable, sutures are open and brain/skull growth is rapid.”
Tummy time or any time spent keeping pressure away from baby’s still-malleable skull is the best way to prevent positional plagiocephaly. Though baby needs to sleep on his back, Hubli suggests parents change their infant’s sleeping position nightly (lay baby on her head’s left side one night, on her right the next and continue to alternate) so baby is less likely to find a favorite spot to rest her head on.
“After 6 to 9 months, most babies are better able to support their heads and stabilize their bodies. As such, the risk of pressure deforming the skull diminishes,” Hubli notes.
Personally, my son never liked tummy time, despite me getting down on my hands and knees to his eye level and placing mirrors and toys in front of him. At the same time, I couldn’t stand to leave him to wail while he struggled. Fortunately, there are other ways to get baby off his back and give those developing neck and shoulder muscles the workout they need.
Alternatives include laying baby across your lap or holding him upright with his head over your shoulder (according to the National Institute of Health). Parents can also try wearing their little one. “Babywearing is a very effective tool in the prevention of plagiocephaly,” shares Diana Coote of Canada, mother and creator of ergonomic baby carrier Onya Baby. “With babywearing, you don’t have to worry about scheduling it in, as is the general recommendation for tummy time.”
If prevention is no longer an option and baby’s head is unresponsive or getting worse despite tummy time and repositioning efforts, treatment may be necessary to reshape your infant’s skull. This is usually where cranial orthotics or repositioning helmets come into play.
Helmets can be custom-fitted according to your baby’s head and made to distribute pressure where necessary. The flattened spots are therefore relieved from further weight and stress.
Helmets, however, recently came under fire when an article, which appeared in The New York Times last May, questioned the effectiveness of the devices based on a study published in the British Medical Journal. The topic drew criticism from medical experts and specialists around the world, as well as parents who saw results in their own children.
Tim Littlefield, vice president of research and development at Cranial Technologies, a company that has specialized in cranial orthotics since 1988, cautions that very few people actually read the study in depth. “It has so many flaws within it,” he adds. For instance, the products that were used in the study are not regulated in Britain and did not fit properly. “If you have poor-fitting helmet, you’re not going to get the results you want, or it’ll make matters worse … the study made a blanket conclusion that all helmets are not effective,” explains.
Here in the U.S., cranial orthotics are regulated by the Food and Drug Administration’s strict standards; moreover, each helmet needs to be properly fitted for each individual. “You can’t really make a small, medium, large,” says Littlefield. “Every child’s head is like a snowflake. There are no two heads that are deformed in exactly the same way.”
Experts caution that treatment is not a one-size-fits-all proposition. “It is not a ‘must’ that one treat positional plagiocephaly,” says Hubli. “Positional plagiocephaly is not a progressive disease; the brain is fine.”
So, if you notice your little one’s head starting to get a flat spot, make sure to observe its progress but don’t panic. The earlier you’re attentive to it, the better the chances of treating it without having to go to more extreme measures.
