If your baby was born with a flat or lopsided head, or if the shape of the head began to change as a newborn, don’t worry, it can return to normal. This clinical condition is known as cranial asymmetry1 or flat head syndrome, and depending on the measurements of the little one’s head, it can be called Brachycephaly, Scaphocephaly, or Plagiocephaly.
It can also occur, though less commonly than the cases mentioned above, in association with Craniosynostosis, depending on which side became uneven. But, for all cases, both mild and severe, there are treatments available.
How to Prevent or Correct a Baby’s Misshapen Head
The two longest diagonals of a baby’s head are what determine if their head is misshapen. Depending on the degree of asymmetry, it can be classified as mild, moderate, or severe.
Cranial asymmetry can resolve spontaneously if the pressure on the area that previously caused the deformation stops. Therefore, the earlier the problem is identified and precautionary measures are taken, the greater the chance the head will return to “normal.” Ideally, these measures should be started between the ages of 3 and 14 months.
Some Important Care
The steps are very simple: first, it’s necessary to change your baby’s position while they’re awake, encouraging them to spend time on their tummy playing at least four times a day, so their head isn’t resting on anything.
IMPORTANT: Babies must be supervised while on their tummy, and should never sleep in this position, as there is a risk of suffocation and sudden infant death.
After that, it’s also recommended to move the baby’s crib, if possible, every week. This is because, even if we don’t realize it, babies have positional and gaze habits, caused by the placement of objects in the room or where the mother’s bed is in relation to the crib.
Some travel pillows specifically designed for babies, which have been tested by pediatricians, can also help prevent head deformation. As a precaution, it’s important to avoid leaving the baby in a car seat or stroller for extended periods. Also, vary how you hold your baby, especially during breastfeeding.
Lastly, if none of the above alternatives are sufficient, the use of a cranial orthosis2, which is a type of orthopedic helmet for infants, may be necessary. This can only be used from five months of age. The helmet is worn nearly all day, for 22 or 23 hours daily. The issue is that this treatment is not cheap. However, the results are efficient and fast, especially for severe cases of asymmetry.
Diagnosis
During diagnosis, the doctor must first identify if the baby has plagiocephaly, brachycephaly, or scaphocephaly, which are very similar conditions3. Sometimes tests such as an X-ray, CT scan, or MRI are ordered to rule out other malformation diseases (which may not have a cure), but it’s usually not necessary to get to this point to recognize flat head syndrome. Visual inspection and measurement with a craniometer are usually enough.
If the diagnosis confirms that the misshapen head isn’t due to a malformation, and is therefore caused by external factors, you can rest assured that the situation is reversible. It could be a case of positional or postural plagiocephaly (PP), for example, caused by the baby’s position in the womb during pregnancy, spending a long time on one side. This happens a lot with “big” babies (over 3.5 kg) and pregnancies beyond 40 weeks. Male babies are also more affected.
When a newborn moves little and spends a lot of time lying down, they may also develop a misshapen head. The pressure from the mattress or pillow can lead to flattening on one side or at the back of the head, on the nape. At this stage, babies lack enough neck strength to support their head. So, if they’re lying down a lot, all the weight goes directly to whichever point is touching the mattress, causing deformation.
Understanding the Causes
A newborn’s misshapen head happens because the baby’s skull is still forming, so any position or pressure on the head, especially up to 6 months of age, can cause cranial deformation on the “moving plates” (sutures) before they turn into bone. Moreover, during this growth phase, the head grows very quickly, so anything that stops one side from growing evenly will quickly become visible as a misshapen head.
Comorbidities and Risk Factors
There are some other factors that may be associated with a baby’s misshapen head, such as craniosynostosis and premature birth. Check the table of main prenatal and postnatal risk factors:
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An interesting fact is that, in Brazil, among the 2.9 million babies born in 2008, according to a survey by the Ministry of Health, about 350,000 babies had positional plagiocephaly. This number has been rising.
In the US, after the American Academy of Pediatrics recommended that babies should sleep on their backs to prevent Sudden Infant Death Syndrome, there was, on the other hand, an increase in plagiocephaly among American infants, reaching up to 13% of newborns.
Since cranial asymmetry isn’t as serious as the risk of sudden death, it is still more advisable for the baby to sleep on their back, and that the treatment and prevention measures mentioned here are implemented.
See Also: Head Circumference: Table of Baby Head Size During Pregnancy
Photo: George Ruiz
