Flat Heads in Infants- Plagiocephaly

flat-head-syndromePlagiocephaly (flat head) is a very common and normal condition of infants.  For decades, since babies have been placed lying down for sleep on their backs (less SIDS- Sudden Death Syndrome), parents have been nervous about the flat head or lopsided (asymmetric) shape of their child’s head.  The May 2013 journal “Pediatrics” has published the study “The Incidence of Positional Plagiocephaly: A Cohort Study”.  This study in Canada looked at 440 infants 2 months old and found 46.6% , or almost half of them had some degree of Plagiocephaly.  

In my 20 plus years of general pediatrics, I have only had a couple of infants who had craniosynostosis, where there is premature fusion of certain sutures on the skull and will result in a progressive distortion of the head shape and growth.  For the other 20-30,000 babies I have cared for, the head shape or flatness resolved and was normal and just a function of slightly soft skulls resting on firm mattresses.  It is appropriate and important that the mattress be firm and you lay your baby on his back, face up, to reduce the risk of SIDS. If the head is symmetric but the back of the head extremely flat, there are tiny donut shaped foam pads that will take the pressure off the back of the skull and distribute it more evenly.

It is rarely ever necessary for you child to be fitted for a helmet, like those children who have severe head shape asymmetry.  I have had great success by instructing parents to lay the baby on his side so the pressure is taken off the side that is always down by preference.  You can roll up a small towel or get a wedge to help keep your less than 6 month infant to stay on one side. It should be added here that the side position is generally discouraged as you don’t want your infant who cannot roll to end up face down (higher risk of SIDS) so if you use this technique you will want to find a way to prevent your baby from ending up face down.

The other maneuver I learned from my chiropractic colleagues was to lay your infant on a firm surface, on their back and place your hands under the skull at the back (occipital area) and gently pull your infant back until they barely start to move.  Relax and repeat that a few times a day.  It’s as if you are trying to elongate (stretch) their spine by pulling on their head.  This is a very gentle pull, while they are lying flat on their backs, and sometimes this releases what must have been a pinched nerve and the head then moves freely both directions.  

 You can read the study here…


Dr. Paul

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