How to prevent flat head syndrome

Flat head syndrome is typically only a cosmetic problem. It won’t compromise your child’s brain growth or development. That said, it’s important to take certain steps to ensure your baby’s skull doesn’t become flat.

What causes flat head syndrome?

At birth, babies’ skulls are soft and malleable. This is what makes it possible for the head to pass through the vagina during delivery. As a result, it’s not uncommon for a newborn’s head to be slightly misshapen. Things typically resolve themselves in the first few weeks after birth.

However, some neonatal syndromes can worsen, and others may arise in the first few months after the baby is born. A flat skull usually starts to be apparent around 2 months of age.

From the time they are born, it’s important to change the way you support your baby’s head, since the weight of a newborn’s head is relatively heavy compared to the rest of their body. Because their neck muscles are weak, their head will tilt to one side or the other while they sleep. If a baby always sleeps in the same position, the bone located behind their ear will gradually flatten. Cases of flat head syndrome have become more frequent, since experts typically recommended that infants should sleep on their backs to prevent sudden infant death syndrome.

In most cases, flat head syndrome only occurs on one side of the head. But sometimes the entire back of the head can become flat, creating the illusion that the back of the neck extends all the way to the top of the head.

The risk of developing flat head syndrome is greater when a baby stays in the same position for a long time. This can happen when the baby is often placed in a seat with a hard surface (such as a stroller, the car, the seat in the grocery cart, etc.). If they are left in their seat for too long without moving, the unique position they are in could change the shape their skull.

How can you prevent your baby from developing a flat head?

• From the time they’re born, make sure your baby’s head isn’t always resting on the same side when you place them in their crib.
• As soon as they’re able to turn their head on their own, make sure it’s not always turned to the same side. To achieve this, alternate the position in which you put them to bed—with their head at the foot of the bed one night, and on the other side the next. A source of noise or visual cue such as a mobile, will attract their attention and encourage them to naturally turn their head to the other side.

• If you are bottle-feeding your baby, alternate the arm you use to support their head during feedings. This will ensure you’re not always supporting the same side of your baby’s head with your elbow.
• Place your baby on their stomach every day. To encourage them, you can lie down while facing them or put a toy in front of them. The Canadian Paediatric Society recommends that babies should be placed on their stomachs every day for at least three periods of 10 to 15 minutes each.
• Limit the amount of time your baby spends with their head resting on a hard surface, such as the floor or in a swing. Their car seat should only be used when they are in the car.
• Encourage your baby to look in both directions by showing them a toy first on their right side, and then on their left.
• Have fun lying on your back “tummy-to-tummy” with your baby. Always keep your hands on them to prevent them from falling.
• Carry your child in a soft baby carrier against you, as this can decrease the risk of developing a flat head.

How do you correct a flat head?

It’s important to consult your doctor if you notice that your baby has a flat head. If treated early enough, ideally before the age of 4 months, the condition tends to disappear in the vast majority of cases. A misshapen skull can also be the result of other causes, such as torticollis or the premature closure of a suture. This requires other types of treatment.

Generally, regularly changing your baby’s sleeping position is enough to restore the shape of their skull within a few months. Physiotherapy exercises may also be recommended to help promote the head’s range of motion.

In rare cases, moulding helmets can help the head regain its shape. These are most useful if the flat head has not improved by the age of 4 months despite repositioning and physiotherapy. They are less effective after 6 months of age. A few studies published in recent years question whether they are useful in cases of moderate to severe asymmetry.

When should you consult a doctor?

It’s important to consult a doctor if you notice that your baby:

• Seems to have a flat head.
• Has limited neck movement, as this could be a sign of torticollis.
• Experiences any delay in their motor development.
• Experiences continuous bulging of the fontanelle while sitting, or if the fontanelle is not yet closing after the age of 24 months.

Things to keep in mind

• Flat head syndrome usually starts to be apparent around 2 months of age.
• To prevent a flat skull, from the moment they are born, make sure your baby’s head isn’t always resting on the same side.
• If you notice that your baby has a flat head, schedule an appointment with your pediatrician.

Scientific review: Dr. Anne-Claude Bernard-Bonnin, pediatrician Research and writing: The Naître et grandir team Updated: February 2020

Photo: iStock.com/YoOura