By Alison Heyerdahl

Understandably, becoming a parent for the first, or even the fifth time brings with it a mix of emotions. From excitement to concern, newborns can evoke it all. Being keenly aware of every feature and movement, a flat area on their newborn’s head will not go unnoticed by doting parents. The American Academy of Pediatrics (AAP) describes flat head syndrome (or plagiocephaly) as an asymmetry of the skull usually caused by a baby’s positioning in or out of the womb.  

Sometimes flat head syndrome is only noticeable a few weeks or months after birth, and then the baby presents with a misshapen head, where one side of the head appears flatter than the other. It is also common in premature infants, who are more prone to skull abnormalities. Although flat head syndrome is typically no cause for concern and does not signify underlying brain abnormalities or developmental delay, it is wise to have the baby evaluated by a doctor.

What causes flat head syndrome?

Babies are often born with a slightly flat head due to having restricted movement within the womb, including a breech position, and early engagement of the baby’s head into the pelvis during pregnancy.   

After birth, flat head syndrome can also occur when babies are positioned on their backs for sleeping. While back-sleeping has dramatically reduced the incidence of Sudden Infant Death Syndrome (SIDS), the prevalence of flat head syndrome has risen dramatically over the last few decades. Placing babies in car seats, strollers or bouncy seats, where they are lying down for long periods during the day, also contributed to the increase in this condition.

Flat head syndrome also commonly occurs in babies with torticollis – a condition in which the muscles on one side of the neck become shortened, causing the head to tilt and rotate to the opposite side. Babies, therefore, have difficulty turning their heads and tend to keep them in the same position when lying down. 

It is important for parents to realize that the presence of flat head syndrome or torticollis in their babies is not their fault. It is a result of factors out of their control and is usually due to safely positioning babies on their backs for sleeping.

Signs and Symptoms

It is easy for parents to notice flat head syndrome in their babies.  

Typically, one side of the back of the head appears flatter than the other. There may also be less hair on the flattened side of the head.  

If torticollis is the cause of the flat head, parents may notice that their child always turns his or her neck to one side and that the head is permanently tilted.

Treatments

• Flat head syndrome often improves with time, and by 6 months old the baby’s head has usually rounded out. Early intervention is always advised, and the following course of action is recommended:

• Repositioning the baby for sleep by placing him or her with the rounded side of the head touching the mattress. Even if the baby moves around in their sleep, it will help reduce flatness. 

• Holding the baby in an upright position for longer periods in the day reduces the amount of time his or her head rests against a flat surface.

• Practicing plenty of supervised ‘tummy time’ with the baby. This will strengthen the neck muscles, in addition to promoting normal shaping of the head.

• Attending physical therapy sessions is effective in treating newborns with flat heads resulting from torticollis. Physical therapists show parents how to stretch the neck muscles and position the baby.

• Special tapes are also often applied to reduce tightness of the muscles.