Plagiocephaly
The most common cause of a flattened head is a baby's sleep position. Because an infant sleeps so many hours on the back of his or her head, the head sometimes assumes a flat shape.
Another thing that can contribute to flattening is torticollis, which means the neck muscles are too tight, have inadequate tone, or are shorter on one side than the other, causing the head to tilt one way while the chin points in the opposite direction.
Premature babies are more prone to positional plagiocephaly — their skulls are softer than those of full-term babies, and they spend a great deal of time on their backs without being moved or picked up because of their medical needs and extreme fragility after birth, which usually requires a stay in the neonatal intensive care unit.
A baby might even start to develop positional plagiocephaly before birth, if pressure is placed on the baby's skull by the mother's pelvis or a twin. In fact, it's not at all unusual to see plagiocephaly in multiple birth infants.
But the differences in head shape seen in children with positional plagiocephaly shouldn't be confused with those caused by craniosynostosis, a more serious condition that occurs when skull bones fuse together too soon, causing an abnormal skull shape and possible brain damage if the condition is not corrected. A child with craniosynostosis may have deformities in the front of the head and a bony ridge over the abnormally fused skull bones. Craniosynostosis is usually corrected with surgery.
Signs and Symptoms
Positional plagiocephaly is usually easy for parents to notice. Typically, the back of the child's head (called the occiput) and the ear on the flattened side may be pushed forward. In severe cases, there may be bulging on the side opposite from the flattening and the forehead may be asymmetrical (or uneven), although this is unusual in full-term infants. If torticollis is the cause, the neck, jaw, and face may be asymmetrical.
Most often, a doctor can make the diagnosis of positional plagiocephaly simply by examining your child's head, without having to order lab tests or X-rays. The doctor will also note whether regular repositioning of your child's head during sleep successfully reshapes the growing skull over time (craniosynostosis, on the other hand, typically will worsen).
If there's still some doubt, X-rays or a CT scan of the head will show the doctor if the skull bones are normally separated or if they fused together too soon. If the bones aren't fused, the doctor will probably rule out craniosynostosis and confirm that the child has positional plagiocephaly.
Treatment for positional plagiocephaly caused by sleeping position is usually easy and painless, entailing simple repositioning of babies during sleep to encourage them to alternate their head position while sleeping on their backs.
Even though they'll probably move around throughout the night, alternating sides is still beneficial. Wedge pillows are available that keep babies lying on one side or the other, but be sure to check with your doctor before using one to ensure that it's appropriate and safe for your baby. The AAP does not recommend routinely using any devices that might restrict the movement of an infant's head.
In addition, you may want to consider moving your baby's crib to a different area of the room. If there's something in the room (a window or toy, for example) that's catching your baby's attention and causing him or her to hold the head in a similar position day after day, moving the crib will coax your child to look at it from another position.
Always be sure your baby gets plenty of supervised time on the stomach while awake during the day. Not only does "tummy time" promote normal shaping of the back the head, it also helps in other ways. Looking around from a new perspective encourages your baby's learning and discovery of the world. Plus, it helps babies learn to push up on their arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen the neck muscles.
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