Since the American Academy of Pediatrics launched its Back to Sleep campaign in the 1990s and the more recent Safe to Sleep campaign by Centers for Disease Control and Prevention, sudden unexpected infant deaths (SUID or SID) has decreased by 50 percent. Both campaigns urge parents and caregivers to place sleepy babies on their backs for sleep.
While researchers and medical providers have learned that back sleeping cuts the risk, they have also seen a simultaneous increase with babies developing plagiocephaly, also called flat head syndrome. Plagiocephaly develops when an infant’s soft skull becomes flattened in one area, due to repeated pressure on one side of the head.
According to Banner Health Clinic family medicine physician Michael Bradfield, MD, most cases of flat head get better with time, but there are cases where repositioning programs are beneficial in treating plagiocephaly.
What causes plagiocephaly (flat head syndrome)?
The most common type is positional plagiocephaly, which is due to pressure on the same part of the head for prolonged periods of time. This happens not only while baby is sleeping but also being in infant car seats, carriers, strollers and swings. Premature babies are more likely to have a flattened head as their skulls are softer than full-term babies and may spend a lot of time lying on their backs because of medical needs, such as the NICU.
Many parents may feel immense guilt and blame over this—feeling like they could have prevented their infant’s flat spot. The truth is, most babies don’t have perfectly shaped heads. In our conversation with him, Dr. Bradfield added, “The most important thing to remember is that plagiocephaly is a reversible, nonsurgical condition, but it is important to be evaluated by a physician. While plagiocephaly will not change a child’s development or neurological outcomes a similar presentation, craniosynostosis can. ”Although positional plagiocephaly is quite common, there are also congenital causes as well. Such as:
- Craniosynostosis is a premature fusion of the skull bones in a child. Occurring in about 1 in 2,500 births (including trigonocephaly, scaphocephaly, brachycephaly), this condition usually requires surgical treatment with or without helmet correction.
- Congenital torticollis, or wry neck, is due to a shortening of the muscle in one side of the neck, causing the head to tilt in one direction. This condition is corrected with intense, early physical therapy.
Your child’s primary care doctor or pediatrician will check your infant’s head for features like: bony ridges, flat spots, an uneven forehead or facial asymmetry.
“Medical tests are usually not needed,” Dr. Bradfield said. “If, however, the diagnosis is not clear or if the condition does not get better with 6 months of conservative measures, your provider may refer your child to a neurosurgeon at a craniofacial clinic.”
Treating positional plagiocephaly
As Dr. Bradfield mentioned, most cases do get better with time, however, there are several simple practices and some treatment options.
- What you can do at home
- Encourage your baby to participate in supervised tummy time as much as possible during awake hours. Since a child’s head continues to remodel the most up to 18 months of life it is never too late to start tummy time.
- Although it may be hard as a busy parent, hold your baby more often to take pressure of their head. Avoid letting your baby fall asleep in their car seat.
- If you always lay your baby down in the crib or your arms in a certain direction, consider varying their position in the opposite direction.
- Important reminder: Continue to place baby to sleep on their back to reduce the risk of sudden infant death syndrome (SIDS).
- Physical therapy
- Most babies with flat head syndrome also have some degree of torticollis. A repositioning program at home in conjunction with physical therapy can have good success in helping your baby lengthen their neck muscles and straighten their necks.
- Orthotic helmet
- In most cases, a helmet is not necessary. However, if you have exhausted repositioning techniques and physical therapy, your infant’s medical provider may suggest helmet therapy. If a helmet is recommended, your doctor will refer you to a certified orthotist.
If you are concerned your baby may be suffering from plagiocephaly or a similar condition, schedule an appointment with one of our Banner Health specialists at bannerhealth.com.