Newborns: Flattened Head Syndrome (Positional Plagiocephaly)

What is flattened head syndrome?

Plagiocephaly is a medical term for a head that has an abnormal shape. Flattened head syndrome is one type of plagiocephaly.

If not properly treated, these changes can remain for the rest of the child's life.

How does it happen?

Babies have very little room inside the uterus towards the end of pregnancy and may get "stuck" in one position. Infants who are in a breech position (bottom down) or twins have less room to move around, but even single babies in a normal position may have so little room that they can't change position. Babies who stayed in one position in the uterus continue to lie in that position after they are born.

A newborn's head is soft and easily molded into a flat shape. If a baby lies on his back with his head turned in one position for a long time, day after day, the head can become flat on the back or on one side. This can cause the baby to have a crooked looking forehead and face.

What are the symptoms?

You can start to see flattening as early as 6 weeks of age. You may notice facial changes within the first 3 to 6 months.

How is it diagnosed?

Your healthcare provider will review your child’s symptoms and examine your child. Many babies have some flattening, and most often, children do not need medical treatment for it.

How is it treated?

Your healthcare provider will recommend that you change your baby’s head position. Often, this is the only treatment your child will need.

Sometimes special stretching exercises or positioning are needed for babies who have tight neck muscles or have been very cramped in the uterus.

If the flattening is affecting the baby’s face, causing the ears to shift, or if the baby also has a neck problem called torticollis, an orthotic helmet may be needed.

How can I help my child?

You can help prevent this flattening by constantly changing your baby's head position. This is especially important when the baby is very young and can't move around a lot.

Here is what you can do:

• Sleeping: Always lay your baby down to sleep on her back. This is important to prevent sudden infant death syndrome (SIDS). However, change your baby's head position each time you lay her down. Lay your baby with the head towards the top of the crib one time and the next time lay her down with her head at the other end. Babies like to look out towards the room and this encourages a baby to move her head to a different side each time she is laid down. Put toys or mirrors around the room to cause the baby to look towards the outside of the crib. Keep soft objects, toys, and loose bedding out of your baby's sleep area.
• Infant seats, strollers, bouncy seats, and swings: Watch to see if your baby likes to put his head to the same side all the time while sitting in a seat. Roll up a blanket or use a neck roll to put around the baby's head to keep the head in the center. Don’t keep your baby in these seats for long periods of time.
• Playtime: It is very important to start placing your baby on her stomach for playtime once the umbilical cord has dried up and fallen off. Time spent lying on the tummy helps develop neck, stomach, arm, and back strength. It also helps to get the baby ready for rolling, sitting, and crawling. Babies don't like lying on their tummies at first because they are weak and it is hard for them to push up. Don't worry if your baby fusses some of the time. Begin for short periods of time (2 to 3 minutes), 3 or 4 times a day. Try it after a feeding or a diaper change. Talk to your baby, place toys in front of him, and encourage him to lift his head and begin to push up. Gradually increase the time spent on the tummy and your baby will get stronger and eventually like to play on her tummy. "Tummy time" is a time for playing with your baby. Do not allow your baby to fall asleep while lying on the stomach.
• Carry your baby: Your baby's favorite place is in your arms. Holding your baby or wearing your baby in a front pack is a great way to get him off his head and move the head in different positions. This also allows your baby to experience a variety of positions and is great for bonding and play.

When should I call my healthcare provider?

Call during office hours if:

• Your baby always wants to lie in one position and resists changing that position. Sometimes special stretching exercises or positioning are needed for babies who have tight neck muscles or have been very cramped in the uterus.
• Your baby's head looks misshapen.