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Flat Spot on Baby's Head

Friday, January 22, 2010
Some babies are born with flat spots on their heads. This is often due to the position they were in while in the uterus, other times it may be cause during the birth procedure or as in many cases it is the result of regularly sleeping with the head in the same position.

All babies are born with soft mouldable heads to allow for their passage through the birth canal.   These soft malleable bones of the skull are not fused and often slide across one another, overlapping a little during birth.  Once born, a newborn has very little head control causing the head to be floppy and roll to one side or the other.  If your baby favours one position in particular, this may become a problem. After as little as four hours of sleeping there will be a tendency for the under side of the head to be a little flatter than the upper side.   You may have see babies who have very round moon-shaped faces. These tend to be babies who have slept on their backs looking straight up.  They often have quite obvious flat spots on the back of their heads.
 
There is no doubt that the incidence of SIDS has been lowered significantly since the introduction of Safe Sleeping Education.  But evidence also suggests that we should make sure that the baby lies with his head turned to alternate sides during each sleep session.  This practice should be started from birth.

As the baby develops and become more aware of his surroundings he may tend to turn his head to see bright objects, light, or the approach of his parents of a carer.  Positioning the cot to make use of this voluntary turning of the head is a very good practice.  Some people find it easier to sleep the baby at alternate ends of the cot.

Placing the baby on his tummy and alternating lying on his right and left sides when awake and supervised is also important.  This practice should be started from birth otherwise baby may dislike being on his tummy for extended periods.  This is often the case with babies 2 months or older.  To help baby enjoy tummy time begin with short periods and keep extending the time until they are able to play happily for up to 60% of their wake time on their tummy.  Baby massage, laying beside them on the play mat, lying while on your chest or across your knees, or after the bath on the change table, can be soothing for a baby and teach him that tummy time is pleasant and fun.  Tummy time is also important for his brain development.

Mild flattening of the head often resolves itself once the baby is sitting up independently.  Don’t be alarmed if you do not see results instantly, as the skull continues to grow and change shape until the age of 18 years.  Aside from introducing good positioning techniques and plenty of tummy time, no intervention is required unless your baby has a severe misshapen head or you notice asymmetry in the face.  This may include forehead bossing and/or ears or eyes not level with each other.  In the more severe cases, a custom moulded helmet is designed to encourage the skull to grow in a more symmetrical manner.  This form of intervention is effective on babies aged between 5 months and 18 months, the most common time to treat is between 6 and 12 months.  The helmet is generally worn 23 hr/day for about 3 months.
  
If you have any doubt about the shape of your baby’s head, you can contact a paediatric physiotherapist and you can get further advice about handling and encouraging good development in your baby.  There is also a brochure outlining the techniques to help in maintaining good head shape of your baby, available from your APA paediatric physiotherapist or through the National Office of the Australian Physiotherapy Association.

Alti Vogel, an Orthotist, has helped put this article together; she works at the Children’s Hospital assisting in the design and manufacture of helmets for babies with misshapen heads.  (Information was also adapted from the Physiotherapy Association of Australia).

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