Head Shape
Defining Flat Head Syndrome: What Parents Need to Know
What exactly is flat head syndrome? This guide defines the condition, explains the difference between positional and craniosynostosis-related deformity, and outlines treatment.
Flat head syndrome presents itself as an irregularity in the shape of the skull, usually at the back or side of the head. Parents typically notice a flat area when their baby is around eight weeks old — they may see that their baby’s head looks a little wide, that one ear is pushed slightly forward, or that the forehead is more prominent on one side. Depending on the type of flat head syndrome the baby has, the head may appear asymmetric or deformed. This is sometimes searched as ‘flat head baby’, but what is actually present is a baby with flat head syndrome.
Because a baby’s skull bones (sutures) do not fully fuse until later in childhood, they are soft and therefore susceptible to changing shape — especially if the baby lies in the same position from birth. Alternatively, any pressure applied to the head of a baby who descended early into the birth canal or remained in a fixed position in the womb can cause flattening where that pressure occurred.
For more detailed information about “flat head in babies”, you can read our informative blog post what is flat head syndrome.
Types of Flat Head Syndrome
There are many different types of flat head syndrome depending on where pressure has been applied and, consequently, the shape of the skull.
There are four main categories of flat head syndrome. A list with a description of each is provided below so that parents can easily identify them:
The most common type of flat head syndrome, plagiocephaly may have led you to think “one side of my baby’s head is flat”. It is typically described as flattening towards the back and side of the head, causing the head to appear asymmetric when viewed from above. Another notable feature parents may notice is that their baby’s ears may not be aligned, with the cheek and eyebrow appearing to be pushed forward on the flattened side.
Parents often ask “my baby’s head is flat at the back — what does that mean?” and in many cases it means their baby has a brachycephalic head shape. Brachycephaly is characterised by a wide head shape that can be very flat across the back of the skull. The back of the head may also be very upright, and in some cases the forehead may be quite prominent.
- Scaphocephaly
This is a long, narrow head shape, sometimes called dolichocephaly. A notable feature is that the baby’s ears may not be aligned — something parents may notice.
- Normocephaly
This is a normal head shape, defined as a baby whose head width is between 78–83% of its length and whose diagonal symmetry is less than 6 mm. Viewed from above, it may resemble the shape of an egg, and is considered normal.
Babies are often brought to us with a combination of brachycephaly and plagiocephaly, although we sometimes also see combinations of scaphocephaly and plagiocephaly. This does not mean a baby has two types of flat head syndrome; it simply describes the location of the flattening. Some researchers tend to mix these two different types of deformity together under a single ‘flat head syndrome’ umbrella.
However, this can be problematic when it comes to treatment (discussed later), because if you are not sure where you started, it is impossible to know exactly where to allow the head to grow afterwards. At CranioWell, we always measure each head shape precisely so we know exactly where to allow growth during treatment.
For more detailed information about the different types of flat head syndrome, please see our article.
There are also skull shape deformities and conditions that are frequently confused with types of flat head syndrome. Craniosynostosis is a rare condition we are sometimes asked about in our clinics. You can find more information about this in our craniosynostosis article.
What Causes Flat Head Syndrome?
So, what causes a baby to have a flat head? There are several reasons that can lead to flat head syndrome:
1. Limited Tummy Time
As a way of balancing the time spent on their back during unsupervised sleep, tummy time is a great way to reduce the proportion of time spent on the back; make sure you are awake and watching your baby during this time. If tummy time is not used as a way of trying to equalise the percentage of time the baby spends on their back versus their front, flat head syndrome can develop.
2. Pressure in the Womb and During Birth
One of the main causes of flat head syndrome is pressure applied to the baby’s head while in the womb. This is most commonly seen in multiple births, as there is less space and therefore a greater risk of pressure being applied to the soft skulls of unborn babies.
Following from the idea of flat head syndrome developing as a result of pressure on the skull, if forceps or a vacuum are required during delivery, these methods can sometimes also cause flat head syndrome to develop.
3. Premature Birth
Premature babies tend to have softer bones and are therefore more susceptible to developing flat head syndrome. In addition, because premature babies are generally smaller and weaker, they may initially tend to keep their head to one side, as they cannot move it themselves.
4. Torticollis
Torticollis, seen as “a tilted neck”, is when the baby’s neck is stiff and this can affect the baby’s ability to turn their head fully in both directions, as well as causing the baby’s head to tilt to one side. The restricted movement and pressure applied to the same area of the head can result in flat head syndrome developing.
5. Sleep Position
Since the Back to Sleep campaign emerged in the 1990s, babies have been recommended to sleep on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS). This policy has saved many babies’ lives. Our recommendation is always to place your baby on their back for sleep and then, when they are awake and you are with them, to make sure you carry out tummy time activities and repositioning.
Preventing Flat Head Syndrome
There are numerous ways to prevent flat head syndrome from developing or to minimise its occurrence while your baby is young. Many health professionals will insist that flat head syndrome will self-correct to some extent. However, it is worth bearing in mind that research has shown that 1 in 25 babies in the population who have a severe form of flat head syndrome at two years of age will still have a severely deformed head shape at ages three and four.
Tips to Prevent Flat Head Syndrome in Babies:
1. Repositioning
Parents generally begin to notice a flat spot on their baby’s head, and since the bones are still soft, changing your baby’s head position when awake during the day and night can have a significant effect on preventing the severity of the flattening from increasing. For advice on how to do this safely, please read our repositioning guide.
2. Plenty of Tummy Time
Just as not doing tummy time can lead to plagiocephaly, the best way to prevent it is to make tummy time a regular part of your baby’s daily routine. If you need more advice on this, we have a complete tummy time guide.
3. Simple Handling Changes
The simplest changes during everyday activities can help prevent flat head syndrome — for example, limiting time in car seats and paying attention to the baby’s feeding position, to ensure they spend only a limited amount of time on their back or with external pressure applied to the back of their head during these activities.
4. Exercises for Torticollis
If your baby has torticollis, there are exercises you can do to relieve the tension in the neck so that it does not lead to flat head syndrome. Please make sure you speak to a doctor or specialist about these exercises before attempting them yourself.
Complications
The side effects of flat head syndrome tend to emerge as your child grows a little older. Practical difficulties such as being unable to wear standard-sized sports helmets and hats can have psychological and social effects on many children. In addition, psychological concern and emotional distress can arise — particularly if a head shape is severe throughout school years — and may carry into adult life. For more information about the long-term effects of plagiocephaly, please read our previous article.
Flat Head Syndrome Treatment
If you have tried repositioning and various other preventive measures as a form of flat head treatment, but the flattening is getting worse or has not reduced, flat head syndrome treatment in the form of cranial reshaping helmet therapy may be helpful.
If your baby is between 4 and 14 months old, CranioWell’s speciality of cranial helmet therapy can be carried out. These helmets are custom-made to allow your baby’s head to grow and to reduce the severity of the skull deformity.
This flat head syndrome treatment can only be carried out up to 14 months of age; after this age, the bones in the child’s skull can no longer be shaped and will have fused.
Is Flat Head Syndrome Treatment Necessary?
You may be wondering whether helmet therapy is necessary to treat your baby’s flat head syndrome. In general, mild to moderate cases of flat head syndrome will improve with the use of the preventive techniques described. However, severe cases are much less likely to be resolved by these methods, and our recommendation is that if your baby’s head shape has not improved by five months, it will need a little help to reverse.
While the cut-off for treatment is 14 months, it is recommended that the treatment option is tried while your baby is still young. Our experience is that the earlier you start, the better the outcome and the faster the treatment.
We appreciate that the decision to proceed with helmet therapy is not something parents can simply notice and resolve on their own. For this reason, you can call our clinic to determine the severity of your baby’s head shape and give you the chance to speak with a clinician before any decision is made. 0312 283 26 91
