How To Prevent Flat Spots on Your Baby's Head

Flat spots on the head, or positional plagiocephaly, is a condition that is becoming more common. In fact, in a recent study researchers in Canada found  some degree of plagiocephaly in almost half of the 2-month-olds they examined!

Why are we seeing more plagiocephaly? More babies are sleeping on  their backs rather than their bellies. This puts pressure on the back of the head.  Babies have soft, malleable skulls  to help them get through the birth canal and to allow for the rapid brain growth that happens during infancy. This makes their skulls sensitive to pressure, especially when that pressure is always in the same place.

We want babies to sleep on their backs to decrease the risk of sudden infant death syndrome (SIDS). Since the American Academy of Pediatrics (AAP) made that recommendation in 1994, the rate of SIDS has dropped by half.

It's important to know, too, that plagiocephaly doesn't cause brain damage. As far as we know, having an oddly shaped head has no effect on  brain function. It can, however, lead to teasing and self-esteem problems if the shape is very abnormal. Parents and pediatricians can help by being aware of the problem — especially because there are ways to fix plagiocephaly  if it's caught early.

The key to preventing flat spots is to change the position of your baby's head throughout the day so that pressure isn't being put on the same spot. To do this, parents should:

• Give your baby "tummy time" when she is awake and being watched. This also helps strengthen the muscles of the baby's chest, arms and neck. Do it for at least a few minutes a few times a day. If your baby doesn't like it, try putting her on your chest while you recline or lie down, with her face up close to yours; that may make it more fun for both of you.
• Carry your baby in a sling or other baby carrier. This takes pressure off the head, and can be a nice way to hold your baby and have your hands free at the same time!
• Vary the position of your baby's head when she is lying down. You may have to literally turn her head so she is facing the other way. Many babies like to turn to the right, as this is the position they are often in as they drop down in the birth canal during birth. If this is the case with your baby, position her seat or bassinet during the day so that the more interesting things to look at are to her left.

Most flat spots are mild and go away once babies are a little older and spend less time lying down. In severe cases, we sometimes prescribe a soft helmet for babies to wear.  It doesn't push or mold the skull. Instead, it shields the skull from pressure and allows the head to grow naturally into a rounder shape.

If you are concerned about the shape of your child's head, let your doctor know at your next checkup. But whatever you do, keep putting your baby on her back to sleep!

Claire McCarthy, M.D., a senior medical editor for Harvard Health Publications, is an assistant professor in pediatrics at Harvard Medical School. She is an attending physician and Medical Communications Editor at Children's Hospital Boston.