Keeping Your Baby's Head the Perfect Shape

by Maud Meates-Dennis

Plagiocephaly

newborn with perfect head shapePlagiocephaly refers to an asymmetric head shape. The term comes from Greek -- oblique head.

Usually there is flattening of one area of back of the head causing a flat spot on the head. The condition is also referred to as positional plagiocephaly or deformational plagiocephaly. Pediatricians have seen increasing numbers of babies referred to them with plagiocephaly since the 1990's, coinciding with advice for babies to sleep on their backs.

The advice for babies to sleep on their backs is sound and research has shown that it is the safest sleep position for babies with the lowest risk of sudden infant death syndrome (crib or cot death syndrome) associated with it. Always put your baby to sleep on his/her back.

Babies don't get plagiocephaly from being put on their backs to sleep but from spending extended periods lying on their backs, particularly if they always tend to lie looking to one side. This can occur because:

  • There is already a flat spot on the head present at birth and the baby's head then always seems to rest on that flat spot. The baby's head is molded in the uterus before birth and this can lead to one area of the back of the head being slightly flat.
  • There is a tight muscle in the neck (the sternomastoid muscle) -- this is called torticollis. The tightness in the muscle means the baby's head tends to look to one side.
  • All the interesting things for the baby to look at are on one side of the room and so the baby always looks to one side. Nobody likes looking at a blank wall.

Whatever your baby's head shape at birth, the body will naturally reshape it to a symmetric shape if it can. However, the bones of the skull are still relatively soft and malleable for a few months, particularly if your baby was born prematurely, and if the head is always lying on the same spot, things will get worse and the head shap e will become more asymmetric over time. The flat spot on the head needs some space, not pressure, to be able to remold.

There are steps you can take to keep your baby's head shape symmetrical:

  • When you put your baby to sleep on his/her back, alternate the side his/her head lies on. Some mothers put a picture on the side of the crib (cot) and change this from side to side at each sleep time (to remind them which side to put the baby's head to sleep and to give the baby something to look at).

  • When your baby is awake and you can watch him/her, give him/her supervised "tummy time".

  • Do not let your baby spend too long on his/her back if he/she is not sleeping.

  • Do not let your baby spend too long in car seats if he/she is not traveling.

  • When your baby is on his/her back, make sure you alternate where all the interesting things to look at are. You might want to turn the crib (cot) around at each sleep or change the end you put your baby's head to make sure your baby doesn't get in the habit of always looking one way.

  • If your baby was born with a flat spot, make sure he/she doesn't always rest on it. A small bolster under the flat spot so the pressure is taken by the other side of the head can be used. Make sure the bolster is small and not something your baby could suffocate on.

Supervised "tummy time" is very important for babies. Not only does it mean there is no pressure on the head but it develops tone in your baby's trunk muscles which is important for his/her later development. It is important that "tummy time" is supervised and you don't let your baby fall asleep on his/her tummy.

Start putting your baby on his/her tummy early to get him/her used to it. Start by putting your baby on his/her tummy on your chest so he/she can see your face. When you start to put your baby on the floor, get down on the floor with your baby so he/she sees your face. Try to have at least 5-10 minutes of "tummy time" per day.

Craniosynostosis

Craniosynostosis, the premature closing of one or more of fibrous boney gaps in an infant's head, occurs in 1 of 2000 births. Usually these "soft spots" remain open until around 18 months of age to allow for rapid brain growth. Craniosynostosis is a birth defect, not a cosmetic issue, and must be diagnosed and treated to prevent long term consequences. Repositioning will not fix this condition.

Common signs of craniosynostosis are irregularly shaped head or a palpable ridge along the skull where the suture has closed.. Many infants are born with an abnormal head shape, due to the trip through the narrow birth canal. When an abnormal head shape persists or is not noticed until after six weeks, it is important to determine the cause. An experienced craniofacial specialist will be able to diagnose or dismiss craniosynostosis.

Torticollis

Sometimes babies have a tight muscle in the neck, which is called torticollis. There are several causes of a tight muscle in the neck, but the important thing is to give gentle stretching exercises to the muscle to prevent it shortening and tightening further. If there is torticollis, the American Academy of Pediatrics advises the following exercises at each nappy change:

  • Holding one hand on your baby's chest, gently turn the head to one side and hold for a count of 10 (turn the head so the chin goes towards the shoulder). Repeat on the other side. Now do that 2 more times on each side (so 3 times in all).

  • Holding one hand on your baby's chest, gently lean the head to one side and hold for a count of 10 (lean the ear towards the shoulder). Repeat on the other side. Now do that 2 more times on each side (so 3 times in all).

Remember, these stretches are gentle -- never force your baby's head. If these simple measures don't help, you may need the extra help of a physiotherapist.

So, by careful positioning of your baby and avoiding extended periods when your baby is on his/her back, you can preserve his/her head shape and avoid plagiocephaly.

References:
• American Academy of Pediatrics. Clinical Report. Prevention and Management of Positional Skull Deformities in Infants. Pediatrics 2003; 112:199-202
• Community Paediatric Review. Royal Children's Hospital, Melbourne. Deformational Plagiocephaly. www.rch.org.au/ccch/pub
• Ministry of Health, New Zealand. Protecting your baby's head shape. February 2004. Code 1227. Ministry of Health, New Zealand

Dr. Maud is a pediatrician who provides easy-to-understand up-to-date health information and practical medical advice for parents of babies and toddlers on her website.

Copyright © Maud Meates-Dennis. Permission to republish granted to Pregnancy.org, LLC.