A newborn baby’s skull is very soft. This softness not only allows the baby’s head to pass through the birth canal more easily but also permit the brain to grow and develop in the first year after a baby is born. A baby’s skull is consists of numerous bones that ultimately fuse together. Before the bones fuse together, a baby’s head can be easily “molded”. A lot of vaginally delivered babies are born with an oddly shaped head caused because of the pressure of passing through the birth canal. Within 6 weeks of birth, this is corrected on its own. But if you notice that your baby still has a soft or flat spot on his skull even after six weeks, it is probably because of positional plagiocephaly. Continue reading to know more about this condition.

What Does Positional Plagiocephaly Mean?

Positional plagiocephaly is a problem in which a soft flat spot is developed on your baby’s head either on the side or sometimes even at the back of the head due to continuous pressure on the skull on that part. This typically happens when a baby sleeps on that side of the head all the time and eventually that side gets pressed against a flat surface or mattress causing the skull bone which is soft and malleable to deform and become a bit oddly shaped. It can also happen if there is a problem with baby’s neck muscles.

Causes Of Positional Plagiocephaly In Babies

Several factors can lead to positional plagiocephaly in babies:

• Medical issues or developmental delay: There are several medical issues (like a baby born with a large head) and developmental delays, which restrict the movement of the baby. Such babies have a higher chance of developing the flat head syndrome
• Sleeping position: One of the reasons of positional plagiocephaly is the position in which baby sleeps. The best way for the newborns to sleep is on the back but sleeping for long hours in that position can lead to the development of a flattened head. Likewise, keeping the baby for a long time in car seats, strollers, swings, bouncy seats etc. increases the chances of developing flat spots
• Premature birth: The skull of preemies are softer than that full term babies. Preemies also do not move their head as often as required as they are most of the times on their back because of extreme fragility and their medical requirements after birth. Both these factors make preemies more prone to positional plagiocephaly
• Pressure on the skull of unborn baby: If a twin or the pelvic bone of the mother puts pressure on baby’s head, baby may be born with a flattened head
• Torticollis: Torticollis is a condition in which the baby has tight neck muscle limiting their neck movement. The babies with torticollis, therefore, tend to look in one direction because turning the neck is hard for them. This can trigger positional plagiocephaly
• Being crowded in the womb: A baby can be born with flat head syndrome if the baby does not get enough space when he is in the womb. This can occur during multiple pregnancies, or an unusual shape of the uterus like a bicornuate uterus, septate uterus, arcuate uterus, etc., or even due to the fibroids that develop inside the uterus

Signs And Symptoms Of Positional Plagiocephaly In Babies

Parents can easily find flattened head syndrome in babies. You will notice that the back of baby’s head called the occiput is flattened on one side and there will be less hair growth on that part of baby’s head. If the problem is severe, then you may see that your baby’s head may bulge from the opposite side of the flattened spot and the forehead may be uneven.
If torticollis is the cause behind positional plagiocephaly, then baby’s face, neck, and jaw may be uneven.

Diagnosis Of Positional Plagiocephaly In Babies

To diagnose flat head syndrome in babies, the doctor will look at your baby’s head for the following features:

• Bony ridges
• Any Flat spots
• Forehead is uneven
• Any kind of asymmetry on baby’s face
• Ears that are not alike
• Movement of his head and neck

The doctor will monitor the shape of baby’s head over few visits to see any significant changes. He will advise you to reposition your baby’s head during this time and if this helps the skull over time then he will diagnose this as a case of flat head syndrome.
Sometimes positional plagiocephaly can also look like another problem known craniosynostosis. This conditions may need a different kind of treatment. If your doctor suspects craniosynostosis, he will recommend you to visit a pediatric neurosurgeon or a craniofacial plastic surgeon for further investigation and treatment.

How To Treat Positional Plagiocephaly In Babies?

A treatment option is determined by the age of baby, cause, and severity of the problem. Basically, the position of the baby’s head should change frequently when the baby is lying down.

• If the movement of the baby’s neck is limited due to torticollis, daily physical therapy exercises are recommended as a part of treating torticollis. These treatment options should be done gently but consistently and they will eventually help to get rid of positional plagiocephaly
• If the baby is very young (less than 3 months) and the situation is not that bad, then repositional therapy alone will suffice. Repositional therapy
  as the name indicates refers to changing the position of your baby’s head. This includes:
  • Altering the position you lay your baby for naps and bedtime will help in strengthening the neck muscles. If your baby’s crib is facing the wall, you can also hang something attractive like a baby mobile just on the other side of the crib for grabbing baby’s attention so that your baby turns his head towards it. But stay away from using any positioners or bumpers as they can only increase SIDS risk in your infant
  • Holding your baby more often will help to reduce flattened spot on baby’s head. If the baby sleeps in stroller or car seat, take him out and hold him on your shoulder
  • Altering your baby’s position during feeding time also helps to prevent flat head syndrome in infants
  • Increasing the tummy time benefits the baby by strengthening his neck muscles and eventually avoiding positional plagiocephaly

If the above treatment options are not successful then the next mode of treatment is corrective helmet therapy
Orthotic helmet is prescribed in severe cases of positional plagiocephaly. The severity will be very intense that the shape of the baby’s face is affected. A custom-molded helmet is prescribed to babies between 4 to 12 month age group where the kids grow quickly and their bones are moldable. This should not be used unless prescribed by a doctor. This is usually recommended if the repositional therapy for 2 to 3 months does not show any improvement and if the symptoms aggravate. This therapy usually lasts for 2 to 6 months depending on the severity of the problem and the time when you start the treatment. This treatment is done along with physiotherapy to get best results.
You may worry and feel dreadful with the mere thought of your baby wearing a helmet for so long but these helmets are very lightweight and babies get accustomed to them in a short period of time.

How To Prevent Flat Head Syndrome In Babies?

It is proven that a baby should lie on his back to prevent SIDS (sudden infant death syndrome). However, there are certain measures that will help to prevent the possibility of flat head syndrome or positional plagiocephaly in babies.

• Alter the position of baby’s head while he is sleeping or while you are holding your baby
• Increase the tummy time of your baby. Give your baby tummy time numerous times every day
• When your baby is awake try to avoid putting him in bouncy seats or swing and cuddle him by holding him upright in your lap
• Encourage your baby to roll over, crawl and reach for toys, hold, grasp, pull and push

What Are The Long Term Effects Of Positional Plagiocephaly In Babies?

Once your infant can sit independently, the flattened head or positional plagiocephaly will get better. As the baby grows, his skull will also grow and eventually even severe cases of the flattened head will improve. Do bear in mind that your baby’s head will never be perfectly symmetrical but slowly as the baby grows, the asymmetry will become less visible. Research have shown that by school age, a flattened head will not be a social or cosmetic problem.
Also do remember that if your baby has a flat head syndrome, it will not affect his brain growth or cause any brain damage.