Does your little one's head look flat? Let's talk about this 'Flat Head Syndrome' (Positional Plagiocephaly)!

You may have noticed that one side of your little one's head is a little flat, or that the shape of their head is a little odd. It's normal for new parents to get a little worried about the smallest things. But there's nothing to worry about. This condition is medically called 'Positional Plagiocephaly'. When we talk about it, we usually call it 'Flat Head Syndrome'. So, let's talk about this in a clear way today, okay?

What is 'positional plagiocephaly'?

Simply put, this is when your baby's head develops a flat spot, usually on one side. This can make your baby's head look a little asymmetrical, meaning that both sides are not the same.

Now, we all know that babies should be placed on their backs to sleep . The reason for this is to protect them from the dangerous condition called Sudden Infant Death Syndrome (SIDS). However, when babies are placed on their backs for too long, this type of head flattening can sometimes occur. The good news is that by changing the sleeping position a little (`repositioning techniques`), this condition can be greatly reduced.

Are there different types of plagiocephaly?

Yes, 'positional plagiocephaly' is the most common type. It is also sometimes called 'deformational plagiocephaly'. There are several other types:

• Brachycephaly: This is when the back of the baby's head becomes flat. The back of the head may appear shorter and wider.
• Scaphocephaly: This type of head is elongated and narrow. It is especially common in premature babies and babies who spend a lot of time in the neonatal intensive care unit (NICU).
• Craniosynostosis: This is a rare and concerning condition that is present at birth. It is also called congenital plagiocephaly. This occurs when the cranial sutures in the baby's skull fuse together prematurely. This causes a deformity in the shape of the head. This is a condition that definitely requires medical attention.

How common is 'positional plagiocephaly'?

Studies have shown that about 50% of babies, which is a lot, can develop this condition. But most of the time, it's very mild. So there's nothing to worry about.

What are the symptoms of plagiocephaly?

These symptoms can vary depending on the type and severity of the condition. In 'positional plagiocephaly', you may see things like:

• A flattened area appears on the front, side, or back of the baby's head.
• It's like the hair is gone in one place on the head.
• The shape of the head has changed and appears to be stretched .
• A forehead, eye, or cheek that appears larger and fuller on one side.
• The nose looks like it's pushed to one side.
• The ears are not symmetrical, with one ear being pushed up or forward.

Why does this 'flat head syndrome' occur?

Think about it, a baby's skull is very soft and can be easily deformed. They sleep on their backs for hours a day. When they sleep like that, they can often turn their heads to one side.

So, if your baby sleeps with their head turned to the same side, the same part of their head is always pressing against the mattress or the surface of the crib. When pressure is constantly applied to the same spot, that part of their soft head can become flattened. Just like a ball of clay flattens out when you press it in one place.

Are some babies at higher risk of developing this condition?

Yes, some babies are at a slightly higher risk of developing this 'positional plagiocephaly' than others.

• Premature babies: Their skulls are more likely to be flattened because they are not fully developed. They are also at risk because they spend more time lying down in the hospital and after they get home.
• Some babies may also have a condition called congenital muscular torticollis along with plagiocephaly. This is when the baby's neck muscles become tight, causing the head to be pulled to one side and turned. This condition of torticollis can be treated with physical therapy (PT).
• Other risk factors:
• Having multiple children at once, such as having twins.
• Assisting the delivery of a baby using instruments such as forceps or a vacuum extractor during birth.
• Being the first child .
• Being a boy .
• Lack of activity.
• 'Tummy time' means less time spent holding the baby on their stomach while they are awake.

How is 'positional plagiocephaly' diagnosed?

You will be able to see this flatness of the head when your baby is about 6 to 8 weeks old. Your baby's doctor, whether you are a doctor or a midwife , can diagnose this by simply looking at your baby and observing the flatness of the head. No special tests are needed to confirm or measure this 'flat head syndrome'.

How is 'positional plagiocephaly' treated?

Treatment for this starts with changing the baby's position. You can do this while the baby is sleeping or awake.

As you change positions over time, the pressure will be evenly distributed across your baby's head, and the neck muscles will also strengthen. You can do these things:

• Change your baby's sleeping position frequently: Babies usually turn their heads towards the light, towards the sound, i.e. towards the window, or towards the middle of the room. So, if you put your baby to sleep with their head up in the crib one day and then put them to sleep with their head down the next day, your baby will turn their head to one side or the other.
• Change the side of your baby's head while he sleeps: After your baby falls asleep, slowly turn his head to the side he doesn't like the most.
• Hold your baby more often: This will reduce the amount of time your baby is lying on a flat surface. When holding your baby, alternate sides and arms when breastfeeding. Have your baby lie on your chest.
• Give your baby some 'tummy time' while you're watching while he's awake: 'Tummy time' is when you place your baby on his stomach. This not only helps with 'flat head syndrome', but it also strengthens the baby's neck, arm and back muscles. Just think how important these muscles will be when your little one starts to crawl!
• Reduce the amount of time your baby spends sleeping in positions where their head cannot turn freely: Avoid spending too much time in curved baby swings or car seats that restrict movement.
• Strategically divert your baby's attention: If you hang a toy or mobile outside the crib, within his reach, he may turn his head to look in that direction.

Important: When doing all of this, you need to do it very gently so as not to harm the baby.

Are there any risks in changing posture?

Changing your baby's position, if done correctly, is not dangerous. However, some sleep techniques can be dangerous. Never put your baby to sleep in these ways:

• Turning the baby to sleep on the stomach.
• Turning them to the side and putting them to sleep.
• Putting soft blankets and toys inside the crib to sleep.

These things increase the risk of SIDS.

How often should I change the baby's position?

A baby's skull has a limited time to be soft and flexible. These repositioning techniques are most effective before the baby is 4 months old. That means it's best to start these things as early as possible.

What if changing your posture isn't enough?

Some babies have torticollis (tight neck muscles) along with flat head syndrome. These babies usually need physical therapy and home exercise programs. A physical therapist will teach you exercises and stretches to help your baby's neck muscles stretch and straighten.

If the plagiocephaly is severe , your doctor may recommend that your baby wear a special headgear called a plagiocephaly helmet. An orthotist will make the helmet to fit your baby's head. The helmet will be looser in the flat areas and tighter in the rounded areas. This will help the flat areas of the head develop. Your baby will need to wear the helmet for several months to adjust to the shape of their head.

How to prevent 'flat head syndrome'?

Changing the baby's position (infant repositioning) is the best way to prevent this. Don't forget to change the side of the baby's head when he's sleeping. In addition, when the baby is awake, give him plenty of 'tummy time' while you're watching. These simple things can make a big difference.

What should I expect if my baby has 'positional plagiocephaly'?

Most babies with plagiocephaly get better on their own. Others may need treatment to correct the condition . It's best to talk to your doctor about your baby's condition.

If changing positions doesn't help, should I see a doctor?

You should be able to correct or at least minimize flat head syndrome by changing your baby's position. The key is to start early and keep at it. But if changing positions doesn't help, or if your baby's neck muscles seem tight, definitely see a doctor. Physical therapy or a helmet may help.

What questions should I ask my baby's doctor?

You can ask the doctor questions like these:

• Will my baby's head heal on its own without treatment?
• Are there long-term effects if 'flat head syndrome' is left untreated?
• How will my baby react to wearing a 'plagiocephaly helmet'?
• Does insurance cover the cost of a 'plagiocephaly helmet'? (This may vary depending on insurance systems in Sri Lanka, so it's a good idea to ask.)
• Can positional plagiocephaly come back after treatment?

Is 'flat head syndrome' bad for my baby?

No, flat head syndrome does not harm the baby's brain or affect the baby's health. However, it can make the baby look a little different. There may be less hair in the flattened area, or the face may be less symmetrical (this may cause some visual difficulties). The baby's ear may appear to be pushed forward on one side of the head, or the forehead may protrude forward. The neck, jaw, and face may also appear asymmetrical.

Is 'flat head syndrome' something else caused by parental neglect?

Absolutely not! 'Positional plagiocephaly' is not something that is caused by the fault of parents or caregivers. In fact, this condition is often caused by something you did right – putting your baby to sleep on their back.

Final Take-Home Message

Positional plagiocephaly, or flat head syndrome, is a common condition in babies, and is usually not serious. Changing the baby's position, especially if started early, is often the best solution.

The most important thing is to always put your baby to sleep on their back to reduce the risk of SIDS. This is the priority.

If you have any doubts or questions about this, don't be afraid to talk to your baby's doctor. They will give you the advice and support you need. Remember, you are not alone, every mother and father thinks about little things like this. It's normal!

` Plagiocephaly, Flat Head Syndrome, Baby's Flat Head, Baby Health, Positional Plagiocephaly, Tummy Time, Putting Baby to Sleep