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Plagiocephaly (Flat Head Syndrome)

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Live Q&A: Shape of baby’s head, when to be concerned (craniosynostosis)

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Flat head syndrome, or plagiocephaly as the condition is medically known, occurs when a flat spot develops on the back or side of a baby’s head. The condition can cause the baby’s head to look. Flat head syndrome, also called positional plagiocephaly, develops in babies because of external pressures on the soft, malleable baby skull.

It is more common now that babies sleep on their back. Newborn babies have a very soft skull and prolonged pressure on the one spot can cause a flattened area to develop as they grow. This means their head can become flat or misshapen if they are constantly lying on the same area of their skull. The incidence of flat head syndrome has increased from 1 in 300 in the 1970s to 1 in 10 today. Does your baby have a flat head?

Today, many more babies have flat spots on their heads, a huge increase from 20 years ago. In fact, it is now common to see babies out in public wearing orthotic helmets and to hear stories about their courses of physical or occupational therapy. Plagiocephaly is a condition that causes a baby’s head to have a flat spot (flat head syndrome) or be misshapen. The most common form is positional plagiocephaly. It occurs when a baby’s head develops a flat spot due to pressure on that area.

Babies are vulnerable because their skull is soft and pliable when they’re born. Researchers found that 47 percent of 440 2-month-olds having routine check-ups had what doctors call positional plagiocephaly where the back or one side of the head has a flat spot. It develops.

Flat head syndrome can and does improve by itself; provided the deformity is only mild, it’s noticed early enough and rigorous repositioning is undertaken to prevent the baby from spending too long lying with their head in the same position. However, there are many cases in which flat head syndrome will not improve adequately on its own. Sometimes a baby’s head is molded unevenly while passing through the birth canal. In other cases, head shape changes after birth as a result of pressure on the back of the head when the baby lies on his or her back. You’ll notice two soft areas at the top of your baby’s head where the skull bones haven’t yet grown together.

Plagiocephaly, or flat head syndrome, is when a baby’s head is flat on one side. It’s linked to a baby sleeping exclusively on his back as well as spending a lot. If your baby has a tendency to spend a lot of time with the head in one position in early infancy, flat head syndromemay develop.

This will be most noticeable when looking at your baby’s head from above. Looking down on the top of the head, you may notice that one side of the head may appear flatter than the other side or it may look very wide.

List of related literature:

A flat head is not a serious problem, but discuss it with your pediatrician if you notice it.

“Your Baby's First Year Week by Week” by Glade B. Curtis, Judith Schuler
from Your Baby’s First Year Week by Week
by Glade B. Curtis, Judith Schuler
Hachette Books, 2010

The fontanel normally appears flat, though it may bulge a bit when baby cries and if baby’s hair is sparse and fair, the cerebral pulse may be visible through it (which is completely normal and nothing to worry about).

“What To Expect The 1st Year [rev Edition]” by Heidi Murkoff, Sharon Mazel
from What To Expect The 1st Year [rev Edition]
by Heidi Murkoff, Sharon Mazel
Simon & Schuster UK, 2010

This fontanel normally appears flat, though it may bulge a bit when baby cries, and if baby’s hair is sparse and fair, the cerebral pulse may be visible through it (which is completely normal and absolutely nothing to worry about).

“What to Expect the First Year” by Heidi Murkoff
from What to Expect the First Year
by Heidi Murkoff
Workman Publishing Company, 2014

During the second or third month of life, some babies begin to develop a flat area on the back of the head.

“The Baby Book: Everything You Need to Know About Your Baby from Birth to Age Two” by William Sears, Martha Sears, Robert Sears, James Sears
from The Baby Book: Everything You Need to Know About Your Baby from Birth to Age Two
by William Sears, Martha Sears, et. al.
Little, Brown, 2008

Occasionally, babies need to wear a positioning helmet to improve head shape.

“Mayo Clinic Guide to Your Baby’s First Year” by Mayo Clinic
from Mayo Clinic Guide to Your Baby’s First Year
by Mayo Clinic
RosettaBooks, 2012

The second factor usually comes into operation in late pregnancy and especially in labour; it depends on the fact that the atlantooccipital joint, on which the head flexes and extends on the trunk, is not centrally placed at the base of the skull but rather more towards the back.

“Beischer & MacKay's Obstetrics, Gynaecology and the Newborn” by Michael Permezel, Susan Walker, Kypros Kyprianou
from Beischer & MacKay’s Obstetrics, Gynaecology and the Newborn
by Michael Permezel, Susan Walker, Kypros Kyprianou
Elsevier Health Sciences, 2015

A newborn skull has a large occiput due to the moulding of the birth process and this has the effect of pushing the head forward when laid flat, thus causing the chin to drop and the airway to become occluded.

“Fundamentals of Midwifery: A Textbook for Students” by Louise Lewis
from Fundamentals of Midwifery: A Textbook for Students
by Louise Lewis
Wiley, 2015

Occipital plagiocephaly, a parallelogram-shaped head with flattening of the back of the skull, is seen with increased frequency since the advice to parents that babies should sleep lying on their back to reduce the risk of sudden infant death syndrome.

“Illustrated Textbook of Paediatrics E-Book: With STUDENT CONSULT Online Access” by Tom Lissauer, Graham Clayden
from Illustrated Textbook of Paediatrics E-Book: With STUDENT CONSULT Online Access
by Tom Lissauer, Graham Clayden
Elsevier Health Sciences, 2011

The latter condition, termed plagiocephaly, may become worse during the first few months of life because the infant will prefer to rest his or her head on one side.

“Textbook of Physical Diagnosis E-Book: History and Examination” by Mark H. Swartz
from Textbook of Physical Diagnosis E-Book: History and Examination
by Mark H. Swartz
Elsevier Health Sciences, 2014

If you are concerned about your baby’s head shape have it checked by a family doctor or paediatrician who will be able to assess the need for a corrective helmet.

“Save Our Sleep: Revised Edition” by Tizzie Hall
from Save Our Sleep: Revised Edition
by Tizzie Hall
Pan Macmillan Australia, 2015

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
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Biography: https://medicine.yale.edu/profile/kutluk_oktay/
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9 comments

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  • you know how human tend to appreciated “looks” so much. I hate my flat back head. It’s looks ugly with short hair style or ponytail

  • My baby head was in in good shape when she born but now after 2 month due to movement her shape has become d form.I put her head in wooden palette. Please give me any more solution

  • This video is one in a series designed to help with development AND head shape.  Please go to this link for the series:   http://www.carolinakinderdevelopment.com/shop/

  • My baby is 2months old having a flat head. He is premature as well so it makes more sense for him to have that, but for the cure how long will it take for it to be corrected?

  • @ninjaiction i think there is a surgical procedure available. the doctor will be placing implants to make the head more symmetrical. i’m also plagiocephalic but i’m not willing to undergo this kind of surgery. sigh, i wish the my pediatrician told my parents when i was still a baby that while plagiocephaly doesn’t have any proven developmental effects it might affect my psychological well-being later in life.

  • My 2month old granddaughter soft spot is long from the front of her head to the back middle of her head and they checked her before we left the hospital saying she don’t need a head protector and I know she does cause if she falls on the back of it on the spot she may die

  • I’m 30 weeks along and my entire pregnancy everything has been perfect and all the tests I’ve had are all negative. Last week at my ultrasound my doctors saw something strange with my childs head. It was a bit lemon shaped and we saw a specialist the next day to check for spina bifida. Not that. So I’m curious about how common it is for a child to form a cone-shape head in the womb and if it’ll go away? Or do I need to get a helmet for my baby?

  • Im trying to position my baby’s head on right side but she keeps puting her head back to left side and now her head a bit flat in left side.. Whenever I force her to her right she gets awake so haaaaard. Then I have to make her sleep again

  • I have mild Plagiocephaly. Unfortunately, I was born at a time when this was not a more well known issue and it went untreated. My face and lower jaw grew asymmetrically, and I’ll be honest, this causes me major self esteem problems and I believe that it contributed to my dull neck pains. I am dreading what other issue may arise in the future due to my cranial asymmetry. This is not simply a ‘cosmetic’ issue, and it’s insulting and reckless to say so, in my opinion. Why take the risk? The human body is genetically programmed to grow symmetrical. Disrupting this harmony is to beg for trouble. I sympathize greatly with the affected population of the ‘SIDs generation’. We shouldn’t have had to be genie pigs for such a preventable issue to gain attention.

    Parents, use your judgement, get informed, and seek prevention before a cure. Also, inform others.