5 Key Points Every Parent Must Know To Prevent Flat Head Syndrome (Plagiocephaly)

Here’s what you need to know to prevent flat head syndrome (Plagiocephaly):

1. The earlier the treatment, the better the outcome.
2. Every parent needs to know the risk factors.
3. There are things that you can do at home TODAY to help prevent flat head syndrome (FHS).
4. What you can do if you already suspect some flattening has occurred.
5. Assessment by a qualified practitioner with a special interest in FHS is VITAL, to ensure that other problems aren’t missed.

Since 1992, there has been an incredible 600% increase in the incidence of FHS or plagiocephaly.

This was due to the introduction of the ‘back to sleep’ initiative worldwide to help prevent sudden infant death syndrome (SIDS).

Thankfully it worked… the incidence of SIDS dropped by a whopping 80%! The downside to the risk/benefit of the SIDS campaign has been a steady rise in FHS.

This is primarily due to placing a baby’s soft, malleable skull in the one position for long periods of time.

Think about this – if you completely filled a balloon full of water and placed it on a hard surface, it would retain most of its shape. This is an example of a fully developed adult skull.

If you were to then take some of the water out, effectively ‘softening’ it and repeat the process, the result would be vastly different. You would then have a ‘flattening’ on the base of the balloon, and a bulging at the front. This is what happens in newborns at risk of developing FHS.

After reading this post, you will be able to:

• Reduce the likelihood of it happening to your baby.

• Identify it if already present, and make changes today to significantly reduce the likelihood of it progressing.

1. Early Intervention Is Key.

“It is completely possible to identify newborns who are at risk for positional plagiocephaly, and help the families of these newborns at risk prevent the flattening from ever happening. ”  Dr Yvette Flores

Here is a clip of Dr Flores explaining the ins and outs of early plagiocephaly detection, and how it can be prevented:

I love this quote from the English poet Alexander Pope:

Often the stresses and strains of labour create tensions throughout the cranium (head), spine and pelvis of a baby, leading to dysfunction.

If left alone, these strains (bent twig) could lead to undesirable compensations (inclination of the tree) that are carried throughout life.

It is much easier to deal with these strains early-on, making it less likely for intervention later in life.

 2. You Need To Know The Risk Factors

I believe every parent should be informed about the risk factors for plagiocephaly.

This would enable adequate education on what can be done by you the parent early, so that FHS can be avoided.

So without further adieu….

i) Intrauterine Constraint – i.e., Not enough room

• First pregnancy (primiparity)

• Multiple birth (twins etc.)

• Breech or transverse positioning

• Uterine fibroids

• Larger than average infant head

• > 40 weeks delivery

ii) Traumatic Birth

• Prolonged labour – especially second stage

• Use of forceps (clamp) or ventouse (vacuum)

• Emergency caesarian section

• Premature delivery

3. There are things that you can do at home to help prevent FHS in your baby

i) Tummy time

From day dot, it is important to give your baby time off of their back. This can come in various shapes and sizes, from time spent on their tummy to having them lie on your chest or carrying them in different positions:

I recommend aiming for 2-3 sessions of time on their tummy per day initially, building up to 5-8. This is entirely dependent on how happy your baby is with this position. If they are not happy, don’t persevere. Do something else for a while and come back to it.

The amount of time is also variable. If they are content, then a few minutes might be possible. If not, 20-30 secs might be all they need. They will eventually develop strength in their neck and be able to tolerate longer periods.

ii) Alternate the direction that they turn their head.

It’s a good idea to observe your baby’s head movement, noticing if they prefer turning their head to one side over the other. 

If you do notice a difference, then when possible encourage them to turn both directions (see more on this below).

iii) Limit time spent in the capsule

Being a father of two, I know how easy it is to rely on the convenience of capsules!

You may have just gotten your baby to sleep on the drive home and are faced with two choices – leave them in the capsule and quietly carry them inside to continue their sleep…

or…

…risk waking them up by performing a ninja-like manoeuvre to get them out of the capsule and into their cot. I know which one I would choose!

Unfortunately, excess time spent in a capsule can have a detrimental effect on their head shape. The reason is due to the inability to move their neck through a full range of motion, therefore spending more time than necessary with pressure on the back of the head.

This restriction in movement isn’t only limited to the head and neck. The rest of their body is subjected to a ‘bananaing’ effect, squashing their hips towards the chest.

My advice here is moderation. Spend as LITTLE time as you deem necessary in the capsule. If they are awake and out of the car, don’t leave them in there. They’ll be much happier being out and free to move in your arms or on a play-mat.

Another great alternative is using a baby carrier/sling. If they fall asleep in there then you are free to get on with your day without having to worry about pressure on their head.

4. What Do I Do If My Baby Already Has Flattening?

Firstly, don’t panic…

Follow all the points stated above AND these:

i) Encourage lying on the non-flat side of the head

For those of you that have already tried this, you’ll know that it can be harder than it sounds. Babies are SO good at finding their way back to the comfortable flat side!

Here are some great tips:

• Position the bassinet/cot so the doorway or direction that you approach is on the unaffected side. The baby will tend to look more towards this direction.

• As with the above, having windows, toys or shiny objects on the unaffected side will encourage them to look that way.

• Try rolling a towel under the affected side. The baby should always remain stable on their back, but a slight raise will encourage them to turn the other way.

• For the co-sleepers, the mother should lie on the unaffected side of the baby. Bubs will tend to turn towards mum (and dinner!).

ii) Get creative with feedtimes!

• Firstly you need to figure out which muscles in the neck are lengthened and which are shortened. For example, if we need the baby to turn its head to the right, the muscles on the left are shortened (from being held in the left rotated position for long periods). We can then aim for feeding positions that optimise the length of these muscles.

• In the example above, feeding from the left breast should be no problem. When changing to the right breast, maintain the positon of the baby’s right arm in against the mum and move to the right breast (football hold). Use pillows to prop the baby and mother’s arms up for comfort.

iii) What about pillows?

There are a few options available for infant pillows, however only one to my knowledge has research backing and is safety certified (TUV certified airflow safety). 

The Mimos pillow is one of the more expensive on the market (around AUD$85-95), although still cheaper than most adult pillows out there!

94% of its volume is air, making it the most ‘breathable’ on the market (you can literally breathe through it).

This also helps regulate your baby’s temperature and reduces any suffocation risk.

An added bonus is that it is safe for families with allergies.

Please note that I neither sell the Mimos pillow nor have any affiliation with their products.

Check out this short video on how the Mimos pillow works:

I would ALWAYS recommend purchasing a pillow in consultation with a trained health professional when treating FHS. This allows for an accurate assessment if a pillow is the safest option for your baby. It also enables the most effective treatment possible of manual therapy in combination with re-positioning advice and pillow support.

I would go a step further, and recommend seeing someone who has experience in treating babies with FHS, and who is passionate about providing the best care possible for your baby.

You can read more on the safety certification of the Mimos pillow HERE.

I have included the research backing these pillows in the reference section at the end of this post.

iv) To helmet or not to helmet…?

Occasionally there are times when an orthotic helmet is required; this may be to reduce the asymmetry in cases of FHS that weren’t able to receive treatment early enough, or if a structural cause is identified.

It is fortunately there as an option if required, and in my experience I have found that babies needing helmet therapy respond well to concurrent osteopathic treatment. This can potentially reduce the time required for helmet therapy. 

5. Assessment by a qualified practitioner with a special interest in FHS is VITAL, to ensure that other problems aren’t missed.

Although rare, there are some conditions that can present as FHS that require further evaluation from a paediatric orthopaedic specialist.

This is why it is absolutely VITAL to choose a healthcare practitioner that is trained in detecting these issues and who has a special interest in the treatment and care of babies.

I believe that it is important to choose a modality that is gentle and from someone who is experienced in the treatment of children. For information regarding how osteopathic treatment may be beneficial in the treatment of babies and children, click HERE.

I welcome your comments or questions in the comment section below … but please realise that I can’t provide professional advice in this context.

References

Ohman, A. “A specially designed pillow Can Decrease Developmental Plagiocephaly in Young Infants”. Health. 2014 (6): 1092-1098.

Ohman, A.  “A specially designed pillow may be used as treatment for young infants with developmental plagiocephaly.” Health. 2013. (5) 2064-2067.

Ohman, A. “A pilot study, a specially designed pillow may prevent developmental plagiocephaly by reducing pressure from the infant head.” Health. 2013 (5).