Many parents are understandably worried when their baby is referred to a doctor for an evaluation for plagiocephaly, also known as flat head syndrome—but there is no cause for alarm.
As an infant’s growing brain pushes the skull’s thin, moldable bones apart, new bone forms at expansion joints, or sutures. When pediatricians see an irregularly shaped skull, they often refer patients to a neurosurgeon or other specialist to rule out craniosynostosis, a rare condition in which a baby is born with a premature closure of one or more of these sutures.
Much more common is an easily treatable condition called positional molding or deformational plagiocephaly. This occurs when babies get into the habit of lying on one side of the head, resulting in repeated pressure that flattens that side and back of the skull.
Deformational plagiocephaly is not a brain problem, does not cause neurologic or developmental issues, and does not require surgery. It is usually a minor cosmetic issue noticeable primarily from behind. For the very small percentage of children who have a significant asymmetric frontal appearance, unaddressed plagiocephaly could affect how people treat them later in life, potentially leading to psychosocial issues.
The key to plagiocephaly is prevention. You can prevent it the same way it is corrected: by encouraging tummy time and changing your baby’s sleeping position.
Unfortunately, many parents confuse the recommendation of placing babies on their backs for safe sleeping with avoiding time on their bellies altogether. Engaging in tummy time while awake is both good for babies developmentally and the best way to prevent plagiocephaly. For babies with signs of the condition, tummy time will keep them off of the flattened portions of their heads as much as possible.
When babies are awake and under supervision, position them on their bellies for as long as they can tolerate. Infants who are used to lying on their backs most of the time may fuss when put on their bellies, so it’s best to start early—within the first month or two from birth.
Early repositioning is important if your baby’s head is starting to flatten on one side or you notice that your baby sleeps with his/her head always turned to the same side—a condition called behavioral torticollis. You can change the sleeping position by propping your baby up to prevent putting pressure on the side he or she prefers.
A variety of commercial devices are promoted to counteract torticollis, but the simplest way to lift a child off the flattened or preferred side is to simply prop up that half of the body about 30 to 45 degrees. The cheapest method involves rolling a dishtowel into a cylinder, wrapping it with some tape to make sure it stays firm, and placing it vertically under your baby from the shoulder to the buttock.
Mildly abnormal face-on skull deformities can almost always be corrected with repositioning, as long as they are caught by age four or five months.
A Word About Helmets
Treating plagiocephaly with a helmet works by applying pressure to the skull in the reverse direction of the pressure that caused the initial molding. Helmets work; however, for the vast majority of children, they are not any more effective than simple repositioning and are much more expensive. That’s why it’s best if helmets are considered only for the small group of kids whose skulls are still severely misshapen at four or five months old.
At the end of the day, plagiocephaly is an aesthetic issue, particularly if it is only noticeable at the back of the head. If you are concerned about it, talk to your pediatrician—but the key thing to remember is the importance of tummy time and repositioning.
Jeffrey H. Wisoff, M.D. is the director of the Division of Pediatric Neurosurgery at NYU Langone Medical Center and professor of neurosurgery and pediatrics. Over the past 30 years, he has made innovative contributions to the surgical treatment of neurological disorders in children—particularly brain tumors, Chiari malformations, hydrocephalus, and craniosynostosis. A renowned expert in the treatment of craniopharyngioma and other brain tumors, Dr. Wisoff has published more than 160 scientific articles and book chapters, and has been an invited speaker and visiting professor at numerous international sites. Dr. Wisoff received his medical degree from George Washington University School of Medicine, and completed a neurosurgical residency and a fellowship in pediatric neurosurgery at NYU.