How to Prevent Your Baby From Getting a Flat Head

By: Bridget Hobbs, PT, DPT

You probably have seen them on babies in the mall, grocery store and at the park.  Baby helmets are everywhere!  Helmets have been used for a long time for safety with children that have seizures, but more recently they are also used to help mold babies’ heads that are flat back into a round shape.

Babies can have flat heads from crowding in-utero, which is very common with multiples.  However, there is an increasing number of cases of babies with flat head from positioning (or lack there-of) after they are born.   In fact, according to an article in the August 2013 issue of Pediatrics , 46.6 % of 440 infants studied from 7 to 12 weeks of age had positional plagiocephaly, or a flat head. Granted 78.3 % of children in the cohort study had a mild form of the condition; it does reveal that positional plagiocephaly is a very common occurrence these days.

When your baby is born, her skull is very soft which has allowed her to travel through the birth canal.  They flexibility of the skull also allows for brain growth in the first years of life.  Because of this softness, the skull is very moldable.  Spending long periods of time in one position can lead to flatness of the side of the head (plagiocephaly) or back of the head (brachycephaly).

The good news is that positional plagiocephaly is preventable.  Here are some tips that can help you manage your little ones’ head shape from day one.

• Alternate the arm in which you carry your child. If you are right handed, it’s really tempting to just hold your baby in your left arm so it frees up the right hand to grab your cup of coffee or something out of the fridge.  However, when you just hold your baby in one arm, they are likely just using their neck muscles to look outward to one side.  Alternating which arm you use for carrying your baby encourages them to look both ways often, making their neck muscles strong and less likely to be tight on one side. Tightness on one side of the neck, otherwise known as torticollis, makes it difficult for your child to change their head position, which can lead to flat head.    In fact, many babies that have torticollis (tightness on one side of the neck) also have plagiocephaly (flat head).

• When placing your baby down to sleep, alternate what side of the crib your baby’s head is on. This way, if baby is looking toward the door of the nursery or at a night light, they are alternating which side they are looking each night (or nap).  You can also switch which side of the changing pad you place your babies’ head when changing their diaper so they are looking both ways equally.  As a reminder, always place your child on their back to sleep.

• Limit the time that your baby is in a container, for example car seats, strollers, bouncy seats and swings. Your baby does not have the ability to move her neck very much when placed in these containers, which can lead to tight neck muscles and flatness of the head.  As a mom of an infant myself, I know it is tempting to leave your child in the car seat when they fall asleep after being in the car.  Once in a while it is fine, and I am certainly guilty of it myself.  However, repeated naps in car seats can quickly become a problem.

• Tummy time! I can’t say this enough…start tummy time early and do it often with your baby.  Some babies really don’t like it, but stick with it and they will gradually get used to it.  If they are really fussy, wait 1 hour after feeding to give their tummies time to settle after a meal.   For more tips on how to make tummy time easier for your child (and you!), refer to my previous blog “Yes! We Want Your Baby to Crawl!”

Tummy time is a good way to prevent positional plagiocephaly. Photo by Lorae Mundt

Because of the “back to sleep” program, which started in 1992, babies are not on their tummies as much.  The back to sleep program has done an excellent job at reducing SIDS, but the tradeoff is that many children get plagiocephaly (flat heads) and torticollis (tight necks) from not spending enough play time on their tummy.   This often leads to physical therapy and a possible appointment at your nearest orthotist or baby helmet clinic.

Luckily, there are many clinics in the area that treat children with torticollis and plagiocephaly.  There are even specialized clinics that just fit babies for helmets and monitor their progress with head shape.  Most children have to wear baby head shaping helmets for a few months before they see good results with their head shape.

Pediatric physical therapy helps with stretching out tight muscles and strengthening weak neck muscles.   It also helps your child with their gross motor skills, such as rolling, crawling and standing, which can often be impacted by tight neck muscles and/or a flat head.   If your child has a flat head and/or tight neck muscles, schedule a physical therapy evaluation with a pediatric physical therapist at Easter Seals Dupage & Fox Valley by calling 630.261.6287.