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Your baby’s head shape: How to prevent head flattening

The rate of SIDS (Sudden Infant Death Syndrome) has greatly decreased since parents and caregivers have followed recommendations to put their babies to sleep on their backs.
Babies who lie in one position for long periods of time, such as with their heads to one side, can develop flat areas on their heads. Flattening can happen because skull bones are very soft until about one year of age.

A flat area can develop quickly over a few weeks or may take several months. The baby may have one ear that sticks out and may have facial changes on the flat side of the head.
Looking down on a normal skull of a newborn child

Looking down on a normal skull of a newborn child

Diagram of baby skull


What is flat head syndrome?

Recently doctors have noticed an increase in the number of babies who have a flattened skull. This skull flattening is called plagiocephaly (play-gee-o-SEFF-ah-lee). While plagiocephaly does not affect how a baby’s brain develops, it can affect a baby’s appearance by causing the head and face to develop unevenly. A baby without plagiocephaly has a normally rounded skull and level ears. Although you may hear plagiocephaly referred to as a type of craniosynostosis (a condition where the skull plates do fuse too early), the skull plates are not fused, but moulded into a different shape – a condition that does not require the surgical treatment needed for craniosynostosis.

What causes plagiocephaly?

Up until about one year of age, the bones of your baby’s head are very thin and flexible. This makes your baby’s head very soft and easy to mold. The most common cause of a flattened head is a baby’s sleep position. For the first few months of life, your baby will not be strong enough to roll over on his or her own. If your baby prefers to look in one direction or if your baby is always on his or her back, part of his or her skull may become flat. This flattening is caused by constant pressure on one part of the skull. This is called positional plagiocephaly. Your baby may also develop a flat spot if he or she spends long periods of time in a car seat or reclining seat.

How can I prevent plagiocephaly?

To prevent your baby from developing a flattened skull, change his or her position often. Put your baby on his or her tummy while awake to play several times a day. Use a firm play surface such as a carpeted floor or an activity mat on the floor. “Tummy time” will also help your baby:

  • Develop early control of his or her head.
  • Strengthen the muscles in the upper body.
  • Learn to roll over.
  • Reach for objects.
  • Learn to crawl.

You can also put your baby on his or her side to play. To keep your baby in a side-lying position, put a firm rolled up towel or blanket behind his or her back.

My baby hates tummy time! What should I do?

Here are some ways to help your baby learn to love playtime on his or her tummy:

  • Laying your baby on your chest is a good way to get your baby used to lying on his or her tummy.
  • Put your baby on his or her tummy after each diaper change. Add a little extra tummy time each day.
  • Give your baby lots of interesting things to look at. Put brightly coloured toys or a mirror directly in front of the baby.
  • Give your baby support by putting a rolled towel under his or her chest. Prop your baby’s arms in front of the towel.

My baby looks in only one direction. What should I do?

Many babies prefer to look in one direction when they are lying on their backs. This is called positional preference. It is most common for babies to prefer looking to the right.

If your baby has a positional preference, encourage him or her to look to the less-preferred side until he or she looks equally in both directions. Here are some things you can do:

  • When you are holding your baby during playtime, use mobiles or brightly coloured toys to encourage your baby to look in the less-preferred direction.
  • If your baby’s crib is against the wall, put your baby at opposite ends of the crib each night. Babies prefer to look out into the room.
  • If your baby’s crib is not against a wall, move a brightly coloured crib-safe toy to encourage your baby to look in a different direction each night.

What should I do if my baby’s head already has a flat spot?

Parents often find that their baby’s head shape improves quickly with proper positioning.

Note the times when your baby is on the flat area. Does it happen:

  • When your baby is sleeping?
  • When you are holding or carrying your baby?
  • When your baby is in the car seat or swing?
  • When your baby is playing?
  • When your baby is on the change table?
  • Other___________________________ .

What can I do?

Position your baby off the flat area as much as possible.

  • Alternate head position every night when you put them down to sleep.
  • Move the crib so that your baby turns his or her head away from the flat area when he or she looks toward the door. Place toys and mobiles so your baby turns his or her head away from the flat side.
  • Provide lots of supervised tummy time and side-lying play when your baby is awake. This helps develop strong neck, shoulder and arm muscles. Make sure your baby has toys that will promote tummy and side-lying play.
  • Avoid long pressure on the flat area of your baby’s head when feeding, holding and carrying your baby.
  • Avoid long periods of time in car seats, baby seats and swings where baby’s head is in the same position.
  • Provide supervised time to play in “Exersaucer” as soon as your baby has good head control.
  • Pick up and hold your baby often.

When should I call the doctor?

If you have followed these suggestions and your baby still has a noticeable flat spot, speak to your baby’s doctor to learn about other help available.

Ask your doctor to assess your baby’s neck motion:

  • If you notice your baby holds his or her head to one side or has trouble turning his or her head, your baby may need neck-stretching exercises.
  • Reshaping of an already flattened head is more likely to occur with good neck motion.
  • Your doctor may recommend either home neck-stretching exercises or refer your baby to see a physiotherapist.
  • Babies who have a severely flattened area that does not correct with repositioning may need to see a specialist. The specialist may suggest your baby wear a molding helmet.

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