Flat Head Syndrome is a general term applied to infants whose cranial development results in a flat area on the back or side of the head (deformational asymmetry). The deformation may be present at birth, or may become apparent after birth; during the first few months of the infant's life. The two most recognised scientific terms for the most common forms of the syndrome are plagiocephaly and brachycephaly. Most commonly the term plagiocephaly is used to describe a flattening at the side of the head in the parietal region and where the length to width ratio is within normal parameters. Facial asymmetry may be apparent on the forehead and you also may notice a misalignment of the eyes and ears. When the flattening extends across the back of the head and the head is wider than usual, in this event the length to width ratio is outside of the normal, this head shape is known as brachycephaly.
Causes of Flat Head Syndrome
Cranial birth deformities can be the result of intrauterine restriction which can be caused by several different factors. Positional moulding in the uterus (in utero moulding) occurs due to the inhibited position of the baby in the womb. It is more frequently seen in multiple births due to the restricted positioning of the babies and their heads. In other cases deformities of the head present at birth can be the result of birth injury caused by methods of assisted delivery (intrapartum moulding). There is also a greater incidence of plagiocephaly developing in infants born prematurely as their heads are much softer. Fortunately, the majority of these deformities caused both in the uterus or during birth improve naturally without need for treatment during the early months of the infant's life. The exception occurs when for whatever reason when the infant is positioned in a way that exerts more pressure on a certain area(s) of the head. In this case, the syndrome may worsen by simple gravitational force turning an initially minor plagiocephalic deformity into a potential long-term problem requiring treatment.
Besides deformities present at birth, paediatricians have reported increases in the number of children with cranial deformities in recent years, particularly unilateral flattening of the occipital bone at the back of the head. This increase has been, at least statistically, compared with the significant decrease over those years in the numbers of cot deaths or SIDS (Sudden Infant Death Syndrome). The connection assumes that the increase in flat head syndrome can be attributed to parents following the positioning recommendations aimed at decreasing the risk of SIDS; specifically, the recommendation that healthy young infants should be placed down on their backs for sleep. The back to sleep advice has reduced Sudden Infant Death significantly and parents should continue to be encouraged to always place their babies on their backs when sleeping. However, during the day when the infant is awake and the parents is with them they should spend as little time as possible with pressure on the back of the skull to allow it to reshape naturally.
Treatment of Flat Head Syndrome
Initial treatment usually involves repositioning of the baby onto their tummy to reduce the pressure on the affected area, known as 'Tummy Time'. This should be done for extended time periods during the day. In addition, repositioning cots and other areas in which the infant spends their day will force them to look in different directions to see parents or other areas of interest around them. It should be noted if the infant cries or appears to have discomfort when they are repositioned as this may indicate a problem with neck pain and this possibility should be addressed as tightening of the neck muscles can be common in infants. This treatment should continue until the age of 5-6 months.
If the problem remains unimproved, parents should consider treatment of flat head syndrome with a helmet for a child while still less than 18 months of age. The ideal time to begin treatment is 4 to 7 months but correction can be gained from starting treatment up to 14 months of age. A cranial remoulding helmet (orthosis) can be designed that provides painless contact over the prominent areas of the skull while leaving protected voids to provide a pathway for growth by the affected areas for more symmetrical skull growth.
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