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Plagiocephaly and brachycephaly (flat head syndrome)

Introduction

Many babies develop a flattened head when they are a few months old, usually from sleeping on their back. It often corrects itself over time and is nothing to worry about.

It happens because a baby's skull is still soft enough to be moulded and to change shape if there is constant pressure on a particular area of their head. The skull is made of plates of bone, which only start to strengthen and fuse together as the child grows older.

Flattening of the head is just a cosmetic problem. It doesn't cause any symptoms and doesn't affect the baby's brain, so their development is unaffected.

This page explains:

  • the difference between plagiocephaly and brachycephaly, the two types of 'flat head syndrome' in babies
  • why some babies are affected
  • what you can do to correct this deformity
  • outlook

Brachycephaly vs plagiocephaly

There are two main ways a baby's head can become flattened:

  • The head can become flattened at one side, causing the head to look asymmetrical and distorted (for example, causing misalignment of the ears). This known as plagiocephaly.
  • The whole back of the head can become flattened, causing a widening of the head. This is known as brachycephaly. Sometimes, the front of the skull may bulge out in compensation.

Why some babies are affected

The main cause of brachycephaly or plagiocephaly is the baby's sleeping position, although other factors play a part too. These are discussed below.

Sleeping position

Brachycephaly and plagiocephaly are commonly caused by the baby sleeping on their back every night. The back or one side of the baby's head (if their head naturally rolls to the side) is squashed against a firm mattress for a long period of time, which eventually forces the soft bone of the skull to flatten.

Once flattened, the baby's head will automatically stay on or roll towards this side and it becomes the preferred side for sleeping and for resting their head during the day.  

The solution, however, is not to change your baby's sleeping position from lying on their back at night. It's important for babies to sleep on their back, as this reduces the risk of sudden infant death syndrome (SIDS).

Insetad, you should aim to change your baby's position during the day to take some pressure of the flattened area - see the section on 'What you can do', below.

Factors in the womb

Flattening of the skull can sometimes occur in the mother's womb.

There may not be enough amniotic fluid inside the womb to cushion the baby (known as oligohydramnios), which means the baby's head can become temporarily deformed as they travel down the birth canal.

Also, it tends to happen more often when there is a multiple birth - for example, when twins squash against each other in the womb.

Giving birth prematurely

Premature babies are more likely to have a deformed skull because they are squeezed through the birth canal when their skulls have not fully developed (the skull becomes stronger in the last few weeks of pregnancy).

Muscle problem

Sometimes, a baby will have tightened muscles in their neck, which prevents them from turning their head one way and means they will always rest their head on the other side, causing this side to flatten. Physiotherapy can help correct this problem (see What you can do, below).

Craniosynostosis

A flattened head may sometimes be caused by the bony plates of a baby's skull joining together abnormally early - known as craniosynostosis. This can pull the baby's head out of shape, and will need to be corrected with surgery (see below).

What you can do

In mild cases of brachycephaly and plagiocephaly, no treatment is necessary. Your baby's skull should naturally correct itself over time, if you take some simple measures to take pressure off the flattened part of their head and encourage them to try different positions. You may find the following advice helpful:

  • Give your baby time on their tummy during the day, and encourage them to try new positions during play time. 
  • Switch your baby between a sloping chair, a sling and a flat surface so there is not constant pressure on one part of their head.
  • Change the position of toys and mobiles in their cot to encourage them to turn their head to the non-flattened side.
  • Consider physiotherapy if your child seems to only be able to turn their head one way - tight muscles in their neck may be preventing them from turning their head both ways.

It may take 6-8 weeks of doing the above measures before you notice any improvement in your baby's head shape.

In cases of craniosynostosis, where the plates of your baby's skull have fused too early, surgery will be needed to unlock and move the bones. Read more about the treatment of craniosynostosis.

Should I try a helmet or skull band?

You may have heard about helmets or headbands, known as cranial orthoses, that aim to improve symmetry of a baby's skull. These custom-made devices are designed to be used in infants aged 6-12 months (during the period of greatest skull growth), to apply pressure to 'bulgy' parts of the skull and relieve pressure from other parts, enabling growth in the flatter areas of the skull. The device may also prevent your baby from lying on the flattened part of their head.

However, their use is controversial. There is currently not enough evidence to say for sure whether a helmet or headband will make any additional improvement to your baby's head shape if the above measures are taken early on.

Also, you should consider the following:

  • a cranial orthosis is expensive, costing about £1700-2500
  • the device usually needs to be worn for up to 23 hours a day, for 6-24 weeks 
  • your baby will need to be reviewed every 6 weeks to check the device is allowing and not restricting head growth, and for any necessary adjustments to be made
  • your baby may find the device uncomfortable, and there's a risk of it causing pressure sores on their head

Outlook

Mild flattening of the head usually corrects itself with simple measures to take pressure off the affected area of the skull.

More severe cases of brachycephaly or plagiocephaly can still be improved over time, but some flattening usually remains. However, the hair may cover this so it is not noticeable, and it's unlikely to result in teasing or bullying at school.

A helmet or headband may help to correct your baby's skull shape, but this is not certain. You should weigh up the inconvenience, expense and possible discomfort to your child before trying this.

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