New advice to prevent and correct flat head syndrome in babies

Since 1992, when the American Academy of Pediatrics began recommending that babies sleep on their backs, the number of deaths due to Sudden Infant Death Syndrome or SIDS - the number one cause of death among infants younger than 1 year of age - has been cut in half, according to the CDC.

However, as the number of SIDS deaths have gone down, pediatricians have seen a dramatic increase in babies having flat head syndrome. About 13% of healthy infants have some form of positional plagiocephaly (which means "oblique head" in Greek).

"[Babies] spend almost all their time on their back," says pediatrician Dr. James Laughlin, "that leads to some positional flattening or molding of the head, depending on how the baby sleeps." 

The longer they do that during the first 2 to 4 months of life, the more likely they are to develop a flattening of the head, says Laughlin, who is the lead author of a new report designed to provide guidance for pediatricians to help prevent, diagnose and manage positional skull deformities in otherwise healthy children.

Most babies' heads are slightly asymmetrical. Their skulls are soft and made up of movable plates (which are necessary for baby to make it through the birth canal).  In between these plates are spaces, which allow the skull to expand so that the brain can grow. If the baby's head always rests on the same spot, the skull plates move in a way that leaves a flat spot, according to the NIH.

The AAP and NIH caution that even though having your baby sleep on its back can lead to a flattened head, parents should not stop placing babies on their backs to sleep.  Asymmetry of the skull when caused by positional molding doesn't cause developmental delays, says Laughlin. "This is cosmetic."

The new report, published in the journal Pediatrics on Monday, suggests that pediatricians should counsel new parents about how to avoid flat head syndrome when they bring their newborns in for their check-ups in the first 2 to 4 weeks of life.

Until a baby is one year old, doctors should also screen for skull deformities at every wellness visit.

Only if the flattening of the head worsens by the time baby is 6 months old and the infant has serious flat spots should head-molding helmets be considered, according to the new guidelines. "There is currently no evidence that molding helmets work any better than positioning for infants with mild or moderate skull deformity," according to the report.

Surgery should only be considered when all other options have been exhausted, and after consulting with a surgeon who specializes in these types of cases.

There are simple steps parents can take to prevent flat spots, and they can also be used to minimize the progression if a positional skull deformity has already developed:

– Increase "tummy" time, which is supervised time during the day when baby lies on its stomach.  A baby should spend at least 30 to 60 minutes a day on it's belly, something that can be done immediately after birth.  This will help develop neck and shoulder muscles, says Laughlin. It has also been shown to "enhance motor developmental scores," according to this new report.

–  The NIH recommends changing the direction your baby lies in the crib each week.  They say this change will encourage the baby to turn his or her head in different directions to avoid resting in the same position all the time.

– Some babies prefer to hold their head to one side. Laughlin suggests laying them down in a different way when they're awake, so they have something interesting to look at on the opposite side. If you have them in a car seat or sitting in something else, you can also change the position to make the baby look in the opposite direction.

– Parents may find their babies sleep well sitting in a car seat, but this is another way they can develop an asymmetrical shape, especially in the first 6 months of life.  So experts suggest babies shouldn't spend a prolonged period of time in a car seat (unless they are in a car of course) or bouncy seat.

– Cuddle!  The NIH says "getting cuddle time with the baby by holding him or her upright over one shoulder often during the day," is another way to prevent flat spots.

"In the majority of these cases, this will correct itself on its own, without any or only minimal intervention," says Laughlin. "Because more than half of infants will improve by 6 months of age, repositioning should be attempted as initial treatment.  In most cases, flat spots usually go away when a baby starts sitting up on its own.