Understanding Positional Plagiocephaly

Parents naturally become concerned if a flat spot begins to form on the back of their baby’s head. Your pediatrician may first recommend positioning and a helmet treatment if the complaint persists to help gently mold your baby’s skull into a rounded shape.

What causes a flat area on my baby’s head?

Many parents begin to blame themselves when they learn that their baby needs a helmet. You may even wonder if the annoying flat head problem, technically called plagiocephaly, can be avoided. The truth is that most babies do not have perfectly shaped heads. In fact, most adults don’t have perfectly shaped heads either. Small flats and slight crookedness are normal. If your baby has a large flat spot on his skull, this is usually a result of birth. Your baby’s skull may have formed irregularly as it passed through the birth canal, or it may have formed because they regularly lie on their back in the same direction.

Your baby’s skull is soft, which means the skull bones move more easily than in adulthood. This allows your baby’s head to pass through the birth canal and allow his brain to grow during infancy. But it also means that constant pressure on the back or side of the head can cause permanent deformities if not corrected.

When does my baby need a helmet?

The shape of your baby’s head does not usually cause brain damage or other developmental problems. So how do you know if you need to buy a helmet for your baby?

Your doctor will check your baby’s head size and shape at each well-child visit. These visits occur approximately every 2 months during infancy. If your baby has a flat head problem that does not improve by about 4 months of age, your doctor may prescribe a helmet. For a helmet to be effective, treatment must begin between the ages of 4 and 6 months. This will allow the helmet to gently shape your baby’s skull as he or she grows. Treatment is generally considered ineffective after age 1 because the skull has begun to fuse together.

What does wearing a helmet involve?

When correcting positional plagiocephaly with a helmet, you must keep the helmet on your baby 23 hours a day during treatment. Most often, helmets are worn by the child for several months. Your child’s helmet will need to be adjusted regularly, once a week, to keep up with their growth and changing head shape.

Other treatment options for positional plagiocephaly

Some studies have shown that simple repositioning techniques can be as effective as wearing a molded helmet. Our tummy time guide may be useful to you.  Your doctor may also recommend physical therapy to correct additional problems, such as torticollis, which often presents as a twisted neck.

These techniques can help you reposition your baby and give the skull the opportunity to correct flat areas on their own:

• Make Tummy Time: Place your baby on his/her tummy every day, under supervision. Let him spend time this way. This allows you to take a break from pressing the back of your child’s head and helps your child strengthen his or her neck muscles.
• Cuddle, hold: Holding your baby isn’t just great bonding time. It also relieves pressure on the back of your child’s head, which naturally occurs when your baby is sitting in a car seat, swing, or carrier.
• Change positions frequently: Try placing your baby in positions that force him to move away from the flat spot on his head. Breastfeed from both sides. Lay him in his crib in different positions so he will have to turn to see you. You can also try moving his crib occasionally so that no spot on his head gets too much pressure or becomes flat.

In most cases, your baby’s head shape will correct on its own. With time and some effort, your baby’s head will grow and return to normal as they begin to move and do more.

Wearing a helmet is a good way to correct any large imperfections or flat spots on your baby’s head. Ask your doctor if your baby needs a helmet and what you can do to fix his flat spot.