'Flat head syndrome' (also called plagiocephaly/brachycephaly) is a really common concern amongst parents of small children. In fact, it affects up to 25% of babies by two months of age. Fortunately, history and experience has taught us that it is usually nothing to worry about and, despite our best efforts, will usually sort itself out! Here's a simplified guide...
Most babies have a bit of flattening of their head early on in life because the skull is soft and easily moulded - it's actually made up of lots of 'pieces' with 'joints' called sutures in between them. This is because the head needs to be able to change shape as it passes through the birth canal, and then allow for the rapid brain growth that happens in babies. On the other hand, it also means that the shape can change depending on the position that the baby’s head rests in. Since babies spend most of their time lying down, the head naturally becomes flatter on the part that is bearing most of the weight.
There are two main ‘types’ of flat head syndrome depending on what part of the baby’s head is affected: plagiocephaly is where the head becomes flattened on one side giving it a distorted appearance, and brachycephaly where it becomes flattened at the back and makes the head look wider or the forehead more prominent. Quite understandably, the number of cases of plagiocephaly and brachycephaly have increased with the emphasis on putting babies ‘back to sleep’ to reduce the risk of SIDS, and this advice should still be followed.
The amount of flattening can range from very mild, which is hardly noticeable, to quite marked and can be very alarming for parents. Luckily, it does not affect the growth of the skull or the brain underneath in any way and, in the vast majority of cases, time is the only treatment needed. However, there are some things that you can do to encourage it in the right direction.
1) As babies grow and start to move around, the head will naturally start to round off too. You can help this along by putting your baby’s head in different positions to take pressure off the affected area. For instance, supervised ‘tummy time’ during the day, spending time in a sloping chair or sling, and encouraging them to look around as much as possible by moving their toys around the cot.
2) In some cases, babies may not move their head because of a muscle problem in the neck and this can be helped with physiotherapy.
3) There is also a current trend towards trying special helmets (or cranial orthoses). However, parents should bear in mind that the evidence for them is not great, and they are both expensive and difficult to use since they have to be worn for most of the day. You may be better off with a bit of time and patience!
In a very small number of children the abnormal head shape is because of an underlying problem, such as the bones of the skull fusing too early. Fortunately, this is rare and a chat with your doctor may help to reassure you, but if there are still concerns then a referral to a specialist for assessment may help sort things out.