What is flat head syndrome in babies?
Often it causes great concern and distress for parents but we are here to guide you through why it my have happened (it’s not your fault!) and what can be done to help your baby.
For some parents when they notice a flatness to their baby’s head it can be very worrying. You may have concerns about how it looks but also many parents fear it will impact on the brain development too.
Well you don’t need to worry. Flat head syndrome is usually nothing to worry about, is purely aesthetic and doesn’t cause issues with the developing brain underneath*. This guide has been put together by specialist paediatric osteopaths, to build your understanding of why flat head syndrome occurs and what the treatment for flat head syndrome in babies is.
Flat head syndrome in babies – what causes it?
The head can be flat cross the back, one side of the back of the head or the side of the head itself. Over time the head starts to look generally asymmetrical and you may notice one ear sits more forwards or the forehead appears more prominent on one side.
So what causes flat head syndrome?
Some parents feel they may have “done something” to cause the flat head but this simply isn’t true.
It is not your fault, it just happens sometimes and often the underlying cause occurred before your baby was even born.
A baby’s head is soft. So any pressure on one area for a length of time may cause it to flatten. Being more fixed in one position makes this more likely to happen.
The main causes of flat head syndrome are:
• Too much time on their backs – Since the “Back to Sleep” campaign many parents have been cautious about putting their babies on their tummies at all. If you baby is awake and supervised they don’t need to be on their backs and should try to spend as much time as possible not laid on their backs. ALWAYS PUT YOUR BABY TO SLEEP ON THEIR BACK
• Delivery – ventouse or forceps deliveries increase the chances of baby developing a flat head
• Neck restriction – Baby prefers turning their head one way more that the other
• Torticollis – Baby has a shortened muscle on one side of it’s neck (torticollis), which leads to restricted neck movement and lying in one position a lot of the time. The baby often looks like the neck is tilted to one side.
• Baby positioning in the womb – sometimes babies get wedged in a certain position low in your pelvis or breech under your ribs and don’t wriggle about as much.
• Multiple birth pregnancies – there isn’t as much space to move and sometimes a baby just gets stuck in an awkward position.
• Premature babies – they often spend time laid on their backs more in special care or intensive care facilities, they don’t get handled as much for medical reasons and often their neck muscles are weaker so they don’t move their head position as frequently.
Most of the time parents don’t notice a flat head at birth because often it isn’t but the seeds can be already sown and it becomes more apparent as the baby grows.
Life of the outside…
In the womb the baby is surrounded by fluid and it’s body (unless pressing against something hard) is floating around freely and there is minimal mechanical pressure on any one part.
However if your baby is laid inside your womb, with its neck turned one way and is wedged somewhere where it is difficult to move it, or pressing up against another baby or is engaged into your pelvis from an early stage, then the baby will be experiencing greater pressures on soft parts of its head.
Being breech means the baby’s soft head is squeezed up underneath your ribs. These babies often end up with a flatness at the side of the head.
Being delivered by forceps or ventouse can be a factor. This is likely due to the baby getting stuck because they were already holding their neck in an awkward position or that there was strain created from the delivery.
Once the baby is born and is lying on harder surfaces, they will often continue to lie in positions they adopted in the womb or following delivery. Their head maybe turned to one side or banana shaped and curled up to one side through their body. Over time the increased and repetitive pressure to one part of the head causes it to flatten.
*See end note on craniosynostosis
Flat head syndrome – Will it get worse or better? What is the treatment for flat head syndrome in babies?
This question is tricky to answer and is different for different babies. We would normally suggest you try repositioning techniques first to reduce the time (and therefore pressure) the baby spends on its back/on the flat spot.
Many babies will improve with repositioning exercises but some may have a more persistent issue. Generally your window of opportunity for shape change, with flat head syndrome, is up until about 12 months of age. After 12-14 months the head shape is unlikely to change. The older the child gets, the less potential for change there is. The sooner you start addressing the repositioning exercises for flat head syndrome, the better.
What can I do as a parent to help? What’s the treatment for flat head syndrome in babies?
Treatment for flat head syndrome in babies should always start with repositioning exercises.
• Tummy time: Tummy time is any position where there back of the baby’s head is free from external pressure. This tummy time is crucial for helping wit flat head syndrome. Some babies don’t like it and that’s ok – focus on little and often until they get stronger and more used to it. Tummy time can be used from birth – as long as your baby is awake and supervised. NEVER LEAVE YOUR BABY TO SLEEP ON THEIR (on your chest upright is fine).
Here are some examples below.
Tummy time can look like this:
or this….
Or this…
• Holding alterations: This means minimizing positions where the baby has pressure on the back of the head or the flat spot. So holding your baby upright over your shoulder and avoiding the traditional cradle hold, especially for feeds. With older babies you can face them outwards but hold them away from your body so their head isn’t resting against your body.
• Car seats: You should try to minimize time spent in car seats
• Neck exercises: If you have noted your baby prefers turning their head one way more than the other, this may be causing the flat head syndrome. Try to encourage movement to the opposite side. For example if your baby seems reluctant to look left, put toys on their left side, talk to them on their left side, sleep them so that you are on their left side, place toys on bar of car seat to their left side.
If you are concerned about torticollis please speak to your GP or healthcare specialist as there can be several different causes for it. The baby may look like its head is tilted to the side one way but the baby is looking the opposite way
• Osteopathy: Osteopaths can work with physical restrictions within the body and joints to gently improve range of movement. If you feel you baby is holding themselves in an awkward position or their neck looks tilted or restricted, we can help to ease muscle tension, improve range of movement and provide bespoke advice and exercises for your baby, with flat head syndrome. Osteopathy for babies is very gentle. Learn more about osteopathy for babies and children.
Osteopathy treatment can help you baby to feel more relaxed and comfortable, addressing some of the factors which may have been the cause of the flat head syndrome. We have specialist pediatric osteopaths who treat babies from all over Cheadle, Stockport, Manchester, Cheshire
- Helmet therapy: This is option for treating flat head syndrome if it doesn’t resolve with repositioning exercises. We suggest conducting your own research on this to see if it is suitable for your baby.
Generally once a baby starts sitting independently, rolling, and crawling the pressure on the back of the head is significantly reduced. This is when you might start to see the greatest improvements in head shape.
If by 5-7 months the head shape is not changing or is getting worse, you may want to get this looked at by a medical professional. As Osteopaths we are happy to advise of the most appropriate next steps if you are concerned about your baby’s head shape.
Safe sleep advice:
Having a baby with a flat head is not a reason to not follow safe sleep guidelines.
Always put your baby to sleep on his / her back.
Since the 1990s there has been a clear link between placing babies to sleep on their backs and a significant reduction in Sudden Infant Death Syndrome (SIDS) / Cot death. Repositioning is to be done when your baby is awake and supervised only.
If you have concerns about your babies head shape and their head or neck movements, please give us a call and we would be happy to help you. Let us support you, ensure you are getting the right advice and exercises to help and support your baby. We support families living in Cheadle, Stockport, Cheshire, Manchester and beyond.
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*A note on Craniosynostosis:
*In rare instances (1 in 2100) a flat / misshapen head can be caused by a condition called craniosynostosis. This is when the joints of the skull (the soft spot for example) close too early.
Signs to look out for include:
• Unevenly shaped head
• Missing, very small or irregular soft spot
• Hard ridging effect of the joints of the skull
• Significantly slower head growth compared to the rest of the body
• Misshaping of the eye socket(s)
• Developmental delay or concerns over muscle tone.
If you are concerned about this please see you GP, who may refer you to a pediatrician for a scan.
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