Protecting Your Baby's Head Shape

by Susan Miller, BScN

At birth, a baby’s skull is very soft and is made up of five separate bony plates that can actually move and overlap as the baby is being born. Because the baby’s head is so soft, in the first few months after birth it can become molded by positional pressure. Now that babies are sleeping on their backs as a protection against Sudden Infant Death Syndrome, there has been an increase in the number of babies developing a flat or asymmetrical head shape. This is referred to as positional plagiocephaly.

The medical term for a flat spot on the back of the head is occipital brachycephaly. When the flattening is to one side, or the head is misshapen from front to back this is referred to as occipital plagiocephaly. In this case, one ear may be more forward than the other or possibly one side of the face is more forward than the other side. Some babies have a combination of both types of the shaping mentioned above.

Head flattening or shaping can also occur while a baby is still in the mother’s uterus. If the uterine environment is crowded, the baby does not have as much room to move and can become stuck in one position. This can happen when the baby is very large, is a twin or triplet, if the mother’s pelvis is small, if the uterus is an unusual shape, or if there is not enough amniotic fluid. If a baby is in the breech position, he can become wedged under his mother’s ribs, resulting in a flattened or misshaped head. Any one of these conditions is no fault of the mother, but it is important to know what to do to minimize the effect before and after baby is born. During pregnancy, it may be helpful for the mother to use the “all fours” position as much as possible to allow the baby to move more freely, and to relieve some of the pressure that she may be feeling. Once baby is born, and if flattening is obvious, it is important to position the baby so that further flattening or misshaping will not occur.

There are some measures that parents can take to minimize the effects of pressure on the back of baby’s head. The Canadian Pediatric Society has issued an information statement addressing this concern, and makes the following recommendations.

Tummy Time
Right from birth, make sure that your baby has supervised “tummy time” each day while awake, (but not right after feeding). Babies need tummy time not only to take the constant pressure off of their heads but also to learn new motor skills and to develop all of their muscles. Many parents report that their baby does not like being on their tummy and fusses when put down in this position. It usually takes a number of short doses of tummy time for baby to become more comfortable with this position. Try lying baby on your own abdomen with him looking up at you. You and your baby can do this while you recline in a chair or on the bed. If you put your baby on the floor, try putting a rolled towel or small blanket under the baby’s chest at about the level of his underarms. This takes some of the pressure off of the baby’s tummy. Babies enjoy tummy time more if they have something interesting to look at too. Make tummy time another opportunity to have fun with your baby.

Counter Positioning
“Counter positioning” is another recommended strategy to use when baby is put down to sleep. Most babies will quickly learn which way to look for you when they are in their crib. Invariably baby will turn her head toward the door. If your baby is constantly looking in one direction she will more likely develop a flat spot on that side of her head. Also, she may over-develop the muscles on one side of her neck and then have a tendency to not want to look the other way. To counteract this “one side” preference you simply position your baby with her head at the opposite end of the crib every other day. This way your baby will use both sides of her body equally and there will be equal pressure on each side of the head as well. To encourage your baby to look out into the room, place a mobile or other interesting object in the direction you want her to look.

Car Seats and Other Recliners
Today it is common for babies to spend a fair amount of time in car seats even when they are not being transported in the car. It is worth mentioning that there is also constant pressure on the back of baby’s head while in a car seat and other carriers such as strollers, swings and some bouncy chairs. This adds to the cumulative time of back lying in 24 hours. Mother Nature did not know about car seats and other infant seats when she designed a baby’s head to be soft in the early months. In other countries around the world, babies usually spend their day being carried on the hip, or in a soft sling on the back or front of their caregiver, not in rigid seats! Try to limit the time your baby spends with his head against a firm surface.

Reshaping Therapy
A minor degree of shaping usually resolves with careful positioning, but some babies are more prone to severe shaping that can become permanent. Although this condition is cosmetically undesirable, brain function and development are not affected. As the child grows, however, there can be social and emotional issues because of an unusual head shape. Special clinics to treat positional plagiocephaly are now in place at some children’s hospitals in Canada so that an irregular head shape can be corrected in infancy.

Check with your baby’s doctor or Public Health Nurse if you think that your young baby has some significant flattening or shaping of the head. Further medical assessment may be indicated, and if specific treatment is needed it can be started sooner rather than later. If careful repositioning has not made a significant difference in six or eight weeks, then baby may need to be fitted with a cranial remodeling band or helmet to gently reshape the head as it grows. This treatment is usually started when the baby is between five and nine months of age when the anterior fontanel is still wide open. The helmet is worn 23 hours a day for approximately six months. Most babies don’t seem to mind the helmet once they get used to it.

Susan Miller, R.N. BScN, is a Perinatal Educator and Certified Breastfeeding Counsellor. She works with prenatal and post-natal families in the Greater Victoria area and is now the proud grandmother of Meredith born July 2008.