A head’s up about flat spots

When my son Jack was born via C-section, everyone had something nice to say about his beautiful round head. “It’s so perfect! Not like the poor little cone-headed babies!” Little did they know that his pretty little spherical skull would soon resemble a pancake on one side.

Does your baby’s head have a flat spot? A flat region?  A flat continent?  Do not fear!  It’s likely normal skull flattening (the fancy medical term is positional plagiocephaly), it’s totally normal, and only rarely do baby craniums need any “fixing.”

Let’s talk about infant skulls – like many baby body parts, they aren’t small versions of the adult skull. They are unique and functional. They are made of bone plates that are loosely held together, and they can move and shift. This special ability helps the baby with an easy exit through the birth canal, and allows the brain to rapidly grow during the first year of life.

However, after that exit, there are lots of external forces that can flatten the infant skull. Often, it’s due to your pediatrician’s golden rule of putting her on her back to sleep. In 1992 we launched this campaign to reduce the rate of SIDS, or Sudden Infant Death Syndrome. What came next was a beautiful drop in the number of babies dying in their sleep, and the unfortunate side effect was the rise of plagiocephaly. 

So your baby is a few months old now, you’ve been putting her on her back to sleep like your pediatrician recommended, and now she’s got a big ole flat spot on the back of her head. What can you do to make it better?

• Give her plenty of supervised tummy time while she’s awake. Find new toys or objects to stimulate her everyday. A mirror is very entertaining! Prop her up on a pillow to give her a little height (And her heavy head a soft landing pad). I find the breastfeeding pillows have the perfect curve for it. 
• Hold your baby while she’s awake to relieve pressure from carriers, swings and infant seats.
• Alternating things in the room to encourage laying on the other side of the head. I found that putting a bright light-up toy, or a mirror, or even myself on a certain side would encourage Jack to look that direction and relieve the pressure on the flat spot. This also works during naps/sleep time – if your baby likes looking out the slats of the crib, flip her head/feet orientation in the crib so that she has to turn her head a different direction.
• There are many commercial items that claim to “round out baby’s head,” with new things coming out everyday. Research these products carefully and bring it up with your pediatrician before making the purchase, to assure they are safe.

When is a funny-shaped head a true medical problem?  If you have concerns about your baby's head shape, always feel free to talk with your pediatrician about it. Pediatricians typically evaluate the shape of an infant's head during the physical exam at the many checkups they gets during her first year. Usually positioning changes (like the ones listed above) can fix a flat head over time, but sometimes a helmet can be used in severe cases to help it along. In rare cases, we advise that a specialist be seen, like a physical therapist or a neurosurgeon.

Rare instances include:

• The flattening has led to facial changes, like a protruding portion of the forehead, and/or one ear that sits asymmetrically to the other.
• A misshapen head that is due to the skull's bone sutures closing too early (called craniosynostosis - your pediatrician is trained to notice signs of this)
• If you notice that your baby has problems with or may even be unable to turn her head to one side, leading to skull flattening, it may be due to a tight neck muscle - a condition called torticollis.

So my point – and I do have one - is that I’ve seen many funny-shaped heads in my office (and witnessed the evolution of a pretty darn cute one at home), and the vast majority fix themselves over time. Always talk with your pediatrician if you’re worried. That’s what we’re here for!

And as for Baby Jack, he did lots of tummy time to help get rid of those flat spots!