I never had a “flat head” problem with my first baby, so I was surprised when I noticed some misshaping in my second baby. A Canadian study released last year said that 47% of newborns have flat spots on their heads. I was not alone then. Here is what I learnt.
For different reasons, some babies start developing a flat head (also called brachycephaly and plagiocephaly) at about 2-3 months of age. In some cases it will correct itself without any intervention, in other cases it may stay forever. This is because once flattened, the baby’s head will tend to remain or roll towards the flattened side. It will become the preferred side for sleeping and for resting their head during the day. If it has not gone by 6 months, helmet therapy or other cranial orthotic therapies are a good, but expensive and possibly unpleasant, solution. Although it is mostly a cosmetic problem, I would still try to avoid it as much as possible.
What can help is to:
1) Monitor if a flat spot is developing – if you are not sure take photographs. In particular of the top of the head from above. You can do so every month or so. Then you can see whether the flat spot is improving or not. These photos will also be useful in case you decide to see a doctor.
2) If you see a worsening flat spot, start taking some initial remedial action (see my picks below).
3) If the initial remedial actions don’t work, and your baby is approaching 5 months of age, take your baby to the doctor. Don’t wait too long. Most things are easy to fix if you catch them early enough. At 6 months there is still a lot still that can be done, at 12 months much less.
Initial remedial actions:
1) Reposition your baby. Change the direction your baby’s head is facing when you put her/him to sleep. For example you can put her/him down with her/his head at a different end of the crib. If the crib is against a wall, she/he should naturally turn the head to look out into the room. You could also hang a mobile outside the crib to attract her/his attention. Don’t use rolled up towels or positioners in the crib to get your baby to keep her head to one side. These can increase the risk of Sudden Infant Death Syndrome (SIDS) and suffocation. Don’t put your baby to sleep on the tummy as this can increase the risk of SIDS.
2) Try to spend the majority of his/her awake time on the tummy. Stronger neck muscles enable babies to move their head around while sleeping so their heads don’t always rest in the same position. To make sure your baby enjoys being on his tummy, take the opportunity to put him on his tummy when he’s not asleep in the first few days of life. Babies who aren’t used to being on their tummy from day one may have to be convinced into it, starting with a minute or two at a time. You can also try some other tummy time options such as laying on your chest- tummy to tummy, laying across your lap, propped on your leg or with a blanket roll under their chest.
3) Try using a special pillow. Please note that no doctors told me to use them. At best they say that special pillows cannot do any harm. I used two that I can recommend a) Lovenest Baby Head Support, and b) The Lilla Kuddis Baby Pillow. I will write about each of them separately.
4) See a cranial osteopath. He can check if there is adequate mobility in the neck to allow the full rotation both ways. If there is not he can help to improve it.
5) Carry your baby in your arms or use a soft sling instead of using bouncers and car seats.
Background (this may or may not interest you):
Starting in the early 1990s, parents were told to put their babies to sleep on their back to reduce the risk of SIDS. While this advice has saved thousands of babies’ lives, experts have noticed a fivefold increase in misshapen heads since then. Interestingly a ‘flat head’ shows up most often in babies who are reported to be “good sleepers,” babies with unusually large heads, and babies who are born prematurely and have weak muscle tone.