Flat head syndrome, is where a baby’s head has an abnormal shape, due to external factors. It is called Brachycephaly, when the baby’s head is flatter at the back. If there is a flattening of one side it is called Plagiocephaly. There is an asymmetry with one of the ears further forward than the other and that side of the head may appear to bulge foreward. The head has an appearance of a parallelogram from above or is abnormally wide or abnormally long. Many babies are born with abnormal shaped heads but it usually corrects itself by 6 weeks. If not, it may be that they have positional plagiocephaly.
Causes:
“In utero constraint” where there is a lack of space in the womb due to more than one baby; if the mother has a small uterus or pelvis, if there is too much or too little amniotic fluid or in breech babies where baby’s head is pressed against mother’s ribs.
Prematurity because their skulls are very soft and malleable and prone to retained moulding.
Torticollis, where one of the muscles in the side of the neck is shortened, causing the head to turn to one side.
Assisted delivery, such as the use of forceps or ventouse.
Positional preference when sleeping and feeding.
A lack of tummy time when awake and observed.
Slow progress of motor milestones such as rolling over or sitting up, leading to more time lying on their backs.
In rare cases, 1 in 1800 to 2200 births, there may be a more serious cause, called Craniosynostosis, leading to a parallelogram shaped head. This is where there is an abnormal early fusion of a suture, so restricting the growth of the skull in one direction, causing it to grow sideways to the direction of the suture. Rarely babies have a triangular shaped head due to premature fusing of the metopic suture in the forehead. This should be picked up at birth and would have to be monitored and maybe scanned and operated on.
Many babies have positional plagiocephaly, due to sleeping on their back and spending a lot of time in car seats, pushchairs etc. There was a big rise in positional plagiocephaly, due to the advice to parents to put babies on their backs to sleep, to reduce risks of Sudden Infant Death Syndrome (SIDS) or cot death. This is still the current advice.
Early recognition of plagiocephaly is important and parents can be taught repositional techniques and stretching exercises and advised to give babies time on their tummies, whilst being supervised. Please contact me if you would like to discuss this matter or suspect your baby may have any of the above.