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Preventing Flattening of Your Baby’s Head
Studies have shown that it’s safest for babies to sleep on their backs. Since the “Back to Sleep” recommendation came out in 1992, infant deaths from SIDS (Sudden Infant Death Syndrome) have been reduced by nearly one-half.

During the same period of time, however, doctors have seen more babies with flattening of the backs of their heads. They call these “positional skull deformities.” Babies’ skull bones are naturally soft and flexible so the baby can be squeezed through the birth canal during childbirth. But when a baby’s head rests for many hours against a hard surface (such as a mattress, car seat or infant carrier), the soft skull can become flattened. Premature babies have even softer skulls and are even more prone to flattening. Studies have found that up to one-half of all babies have some head flattening.

How can I prevent flattening of my baby’s head?
Most babies experience some misshaping of their skulls, but in most cases this resolves without any problem. If your baby was born by vaginal delivery, you might have noticed that his head came out misshapen or pointed, but the shape became normal over the first few months of life. Most positional skull deformities result from spending many hours lying down and resolve between 6 and 12 months of age, once babies start spending less time on their backs and more time sitting up and crawling.

The American Academy of Pediatrics recently issued recommendations for preventing positional skull deformities in infants. Here is a summary of the recommendations:

  • Always put your baby to sleep on her back, unless your doctor recommends a different position. Even though this might slightly increase the chance of head flattening, it is crucial to protect your baby from SIDS.

  • Alternate your baby’s position in the cot each time you put him to sleep. One night, put him to sleep with his head at the head of the cot; and the next night, with his head at the foot of the cot. Since babies naturally spend more time turning their heads toward the door (to look for you coming into their room) or the window (to see the light), this will give him practice turning his head equally in both directions.

  • Try to minimize the amount of time your baby spends in a car seat, baby carrier, swing, or bouncy seat. These seats can also put pressure on babies’ heads. Always keep your baby in the car seat when you’re driving. But also think about times when you could walk instead of drive, and carry your baby in a front-pouch, sling, backpack, or stroller. Also, when you’re at home, take your baby out of the seat and spend time holding and cuddling him.

  • Give your baby lots of supervised “tummy time” when she’s awake. Playing on her tummy helps take the pressure off the back of her head and also helps her strengthen her upper body, arms and neck. (See the article on this web site, “Tummy Time Play.”)

  • Take your baby to the doctor for his regular well-baby visits. The doctor will check the shape of your baby’s head and neck motion at each visit.
What if my baby develops flattening of his head?
If you notice any flattening of your baby’s head or problems turning his head, be sure to mention it to the doctor at your next visit. The doctor will examine your baby and determine the cause. Usually, the diagnosis is made just by examining the baby, but sometimes x-rays or a CT scan might be necessary.

If the cause is positioning:
The doctor would recommend that you follow the measures listed above. Some might recommend that you position your baby to lie more on the rounded side of his head, looking away from the flattened side. You could also move the baby’s cot to a different position in his room, requiring him to look away from the flattened side to see things of interest in the room. In most cases, the flattening resolves within several months. Rarely, if the deformity is severe and doesn’t improve, the doctor may refer your baby to a pediatric specialist who could advise whether a special skull-molding helmet or surgery would be helpful.

If there is another cause:
Some babies tend to keep their head turned to one side because of a problem with the neck or shoulder muscles, called “torticollis.” If your baby has torticollis, the doctor may advise you to stretch your baby’s neck muscles very gently at each nappy change: pointing the chin toward each shoulder, then each ear toward the shoulder. Each stretch is held for 10 seconds, and the series is repeated 3 times. These gentle exercises usually improve the problem within a few months. If the neck problem persists, the doctor may refer your baby to a physical therapist.

Very rarely, a baby’s skull plates fuse together prematurely, causing an abnormal skull shape. An x-ray or CT might be necessary to confirm this diagnosis. In this case, surgery would be necessary to correct the condition.

In all, remember that mild flattening of the head is common in babies and usually resolves within the first year. Talk with your doctor if you have any concerns. For more information, visit the web site for the American Academy of Pediatrics at www.aap.org.