If you are not yet a parent or a very new parent, you may have seen babies in soft helmets when you have been out and about. Are they to protect the child’s head from falls or bumps? Do these “helicopter” parents purchase these helmets just to ensure their babies don’t hit their heads on anything?

The short answer is no.

The long-ish answer is that their child suffers from plagiocephaly or, in layman terms, flat head syndrome.

The long-er answer is explained below.

My first daughter was a dream baby in her first few months of life. She slept in long stretches during the night, she took great naps, and she was a-ok with laying on the ground playing with her exercise mat while I got stuff done around the house.

She was a back-sleeper in the beginning which made it easy for my new mom temperament. And every time I went to wake her up (as I had to sometimes because she would just sleep for SO LONG --she basically tricked me into procreating again because she was soooo easy-- her little head was always turned to the same side.

I thought this was adorable. Until I realized that her head was becoming misshapened and flat on the back and on one side.

She was about 4-months old at the time. I contacted her pediatrician who put in a referral for me to see a occupational therapist. My daughter was just 1 or 2 centimeters away from needing to be fitted for a helmet — something our insurance wouldn’t cover. So we opted for at-home occupational therapy treatments instead.

I’m happy to report that my daughter, now 10 years old, has a perfectly shaped head (sometimes I wonder what’s going on inside her head but that’s a different story for a different time. Pre-teen years are hard, ya’ll!).

What is flat head syndrome or plagiocephaly?

According to the definition provided by Healthline.com, flat head syndrome or plagiocephaly is defined as, “…the condition [in which] a flat spot develops on the back or side of a baby’s head.”

Many times parents will notice that their baby’s head starts to flatten on one or two sides as they reach their second, third, and fourth month of life. This is because a baby’s skull is not quite fused together and is quite soft and malleable their first year of life. This makes it much easier for the baby to come out of the birth canal, which is great. However, as they get older, too much time spent lying on their backs or on one side can cause their skull to flatten.

There are two types of plagiocephaly which are described below.

What are the two types of flat head syndrome?

There are two types of plagiocephaly: one is called positional plagiocephaly and the other is congenital plagiocephaly.

Congenital plagiocephaly is as explained by healthline.com as a rare birth defect. “In babies with this condition, the fibrous spaces between the skull bones, known as sutures, prematurely close. This results in an abnormally shaped head.” Congenital plagiocephaly is also known as craniosynostosis.

Positional plagiocephaly is much more common and something that you will more likely experience as a new parent with your baby, especially if they are deceptively good sleepers like my first daughter. Positional plagiocephaly is caused by a baby spending a significant amount of time lying on one side of their head. The American Academy of Pediatrics states that this type of flat head syndrome affects up to 50% of babies in the United States.

What are some risk factors of congenital plagiocephaly?

Positional plagiocephaly can often be remedied at home or with certain therapies as explained below. Congenital plagiocephaly however, is more difficult to treat and is not something you can always prevent. Here are some risk factors for congenital plagiocephaly:

  • Being a multiple- It’s hard to move your head around in a crowded space! Limited space in the uterus may cause your baby to have less of a range of movement, and they may favor one side because of it.
  • Preterm birth- Preterm babies have softer heads that are more malleable, making it easier for plagiocephaly to occur.
  • Forceps or vacuum delivery
  • Muscular torticollis- In this condition, a child’s neck muscles are stiff or imbalanced. It is often caused by limited space in the uterus or being breech. This can cause the baby to favor one side, even in utero, causing congenital plagiocephaly.

How do I know if my baby has positional flat head syndrome?

If your baby loves her sleep or spends a lot of time on her back or on one side, you will want to check for positional flat head syndrome. The best time to check the following symptoms and signs is when your baby’s hair is wet, like during bath time, so you can see the shape of the head more clearly.

Positional flat head syndrome symptoms include:

  • A flattened area on the side or back of the head. Instead of being round, the head may appear slanted in a certain area.
  • Ears that aren’t even. A flattening of the head can cause the ears to appear misaligned.
  • A bald spot in one area of the head.
  • Bony ridges on the skull.
  • Lack of a soft spot (or fontanel) on the head.

Things that can cause positional flat head syndrome include:

  • Sleeping position: We have all heard that “back is best” for sleeping positions for your baby but too much time sleeping on their back can use positional flat head syndrome. It can even cause a flat spot on one side of their head if they favor turning their neck towards a particular side while they sleep. Although it is recommended that your baby sleeps on their back no matter what, you may want to vary where they sleep like using a baby carrier for nap times.

  • Insufficient tummy time- Most babies don’t really like tummy time, which makes it hard to let them play this way. But even a few minutes at a time several times a day can help prevent positional flat head syndrome. (Among many other things. Tummy Time is SUPER important!) Tummy time doesn’t always have to be on the ground. You can lay down with your baby on your stomach or even hold them in a baby carrier, allowing them to see your face.

How can I prevent positional plagiocephaly?

Luckily, there are several ways you can help prevent positional flat head syndrome in your baby. And many of the things you can do listed below can be done at home without any intervention from an occupational therapist.

  • Counter position therapy- This is not so much a therapy as it is a process at home. However, for some babies with muscular torticollus, it may be prescribed to be done with an occupational therapist. Counter position therapy basically means turning your baby’s head to different sides when they are sleeping and when they are awake. Most babies tend to favor one side over the other, so turning their heads while asleep, during tummy time, or while in a baby carrier is important.

  • Change sleeping positions- Always put your baby to sleep on their back, especially if they are being left alone in a crib or bassinet. But let some naps be in a baby carrier, wrap, or even in your arms to help prevent positional flat head syndrome.

  • Exercises- There are certain exercises you can do at home or with the help of an occupational therapist. They may include counter position therapy and stretching exercises. But it is important that you do these exercises under the direction of a doctor or therapist and never on your own.

  • Tummy time- Tummy time can be frustrating because most babies don’t like it, especially in the early months. But spending just 2 to 3 minutes at a time several times a day (it is usually recommended as a total of 20 minutes per day) can significantly reduce the risk of positional flat head syndrome.

  • Hold baby upright- Parents usually find themselves holding their new babies in the cradle position most of the time. But holding your baby upright sometimes, either while they are awake or asleep, can help relieve some of the pressure on their head that may cause flat head syndrome.

  • Change feeding positions- Always feeding your baby in the same position, like the cradle position, can cause flat head syndrome. With breastfeeding mothers, it is easy to switch positions when you switch breasts. But for those that bottle feed, they may find themselves using the same position each time because it is more comfortable for their dominant arm. Switching it up can help prevent positional flat head syndrome.

What if my baby’s head stays flat after at-home remedies?

If your baby’s head still has a flat spot that isn’t going away, your doctor or occupational therapist may recommend a shaping helmet. These often have to be worn 24 hours a day for an extended period of time.

Another option, although very rare and extreme, is surgery. However, flat head syndrome is often considered cosmetic so doctors will not usually perform surgery unless it is completely necessary.

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