If you’ve noticed what appears to be a flat spot on your baby’s head, the first thing you should do is take a deep breath and realize it’s probably temporary and no danger to your child’s health. Babies’ brains nearly double in size during the first year of life. Their skulls are designed to accommodate this, along with that passage through the narrow birth canal during delivery. But that malleability also makes it possible for head shape abnormalities like flat spots to develop.
Causes of Flat Spots
Since the bony plates of the skull don’t fully fuse together until age six, there are several factors that can cause abnormalities, including:
Plagiocephaly - Also referred to as a positional skull deformity or flat head syndrome, this occurs when a baby spends too much time in one position, resulting in a change in the shape of the head or flat spots. Rest assured that these flat areas are cosmetic and do not put pressure on the baby’s brain. An estimated 50 percent of infants experience some degree of this, with approximately 20 percent developing flat spots due to positioning in utero or during vaginal delivery. Most parents will notice flattening during the first three months, as newborns spend much of their early days sleeping on their backs.
Torticollis – An abnormality — usually tightness — of the neck muscles, known as the sternocleidomastoid muscles. This may result from intrauterine positioning or occur over time as the baby grows. You may notice your baby favors looking towards one side, which can mean torticollis is occurring. Treatment typically includes encouraging babies to improve their neck range of motion with stretches at home or physical therapy. Surgery is sometimes needed but isn’t common.
Craniosynostosis – A rare congenital condition where the bones of the skull fuse together too soon. Your pediatrician will monitor your baby’s head shape during visits to ensure proper growth and development. If there is a concern, they will refer you to a specialist for evaluation and possible CT scan. Affecting an estimated one in every 2,000 babies in the U.S., this condition may require surgery to correct head shape and provide room for the brain to grow.
Early detection is essential for preventing the progression of flat spots. The American Academy of Pediatrics recommends infants sleep on their backs at night to prevent the risk of Sudden Infant Death Syndrome (SIDS). And since newborns sleep between 14 and 17 hours each day, it’s important that they spend time in other positions. Consider these techniques:
Gently turn your baby’s head if they favor one position.
Encourage supervised side-laying position.
Aim for a collective 80 minutes or more per day of supervised tummy time by three months of age.
Most parents notice a change or improvement in head shape between four to six months. It’s by this age that many infants become more mobile, turning their heads on their own and rolling from back to belly, naturally decreasing the amount of time spent on their backs or in one position.
In rare instances, helmet therapy may be recommended for babies with moderate or severe flattening around six to eight months of age. In these cases, a cranial orthotic company will mold a custom helmet to be worn 23 hours per day for about three months.
Helmets encourage growth in the flat spot, but do not actively reshape the child’s head. Parents will often notice that some degree of flattening remains. Also, since the flattening is cosmetic, insurance may or may not cover the helmet. The desire for symmetry can often increase parental anxiety, but it’s important to recognize that no one has a perfectly round head. And while growth slows after the first year, changes continue to occur throughout early childhood.
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