Flat head syndrome, also called positional plagiocephaly, develops in babies because of external pressures on the soft, malleable baby skull. It is more common now that babies sleep on their backs, as recommended by SIDS safety guidelines. While one in five children are affected by flat head syndrome, parents receive mixed messages about whether it has an impact on development, and clinicians don’t have good evidence to allay fears.
What is flat head syndrome and why does it develop?
The most common cause of a flattened head is a baby’s sleep position. Infants are on their backs for many hours every day, so the head sometimes flattens in one spot. This happens not only while they sleep, but also from being in infant car seats, carriers, strollers, swings, and bouncy seats.
Premature babies are more likely to have a flattened head. Their skulls are softer than those of full-term babies. They also spend a lot of time on their backs without being moved or picked up because of their medical needs, such as a stay in the neonatal intensive care unit (NICU).
Flat head syndrome can even start before birth if there’s pressure on the baby’s skull from the mother’s pelvis or a twin. In fact, many babies from multiple births are born with heads that have some flat spots.
Flat head syndrome is caused by tight neck muscles that make it hard for babies to turn their heads. This neck condition is called torticollis. Because it’s hard to turn their head, babies tend to keep their heads in the same position when lying down. This can cause flattening. Then, once the head has a flat spot, the torticollis (tor-ti-KOLL-iss) can get worse.
It takes a lot of energy for babies to turn their heads. So those with severe flattening on one side tend to stay on that side, and their necks become stiff from lack of use.
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