Flat Heads on the Rise | Treating Baby’s Asymmetrical Head | Are Helmets Necessary?

The Importance of Tummy Time for Baby’s Developing Head

Parents can use tummy playtime to avoid their infant developing an asymmetrical (or flat) head, and they can remedy “positional plagiocephaly.”

New parents protectively swaddling their newborn are typically sent home from the hospital with directions on how to care for their bundle of joy. They’re told how to change a diaper, how often to feed the baby, and when to start using a bath.

And then there’s one of today’s most important directives: Make sure to place the baby on her back when she goes to sleep. Many parents fearing sudden infant death syndrome (SIDS) — the risks of which can be diminished by back sleeping — can go overboard and never put their newborn on his or her belly.

Physicians are pleased that the incidence of SIDS has decreased by more than 40 percent nationally since the American Academy of Pediatrics (AAP) started advising parents in 1992 to put their babies to sleep on their backs. But there has been an unexpected side effect: flat heads. Though there are no national statistics on it, pediatricians say they are seeing an increase in the number of babies with flat spots on their heads.

Flat Heads on the Rise

Dr. William Butler, a pediatric neurosurgeon at Boston’s Massachusetts General Hospital for Children, says it’s “probably not coincidental” that he’s seen a boost in the number of patients with cranial flat spots, a condition which he says is cosmetic. If an infant spends most of his time on his back or with his head in one position, the weight of his head — which is soft and malleable — can temporarily flatten his skull.

“There might be a little more increase in the flatness of the head, but it’s not a permanent condition,” says Dr. Marian Willinger, a member of the national task force on SIDS and a researcher at the National Institute of Child Health and Human Development.

Treating Baby’s Asymmetrical Head

If an infant develops an asymmetrical head, Drs. Butler and Willinger say there are several things parents can do:

Tummy Time. One suggestion offered by experts is to allow an infant to spend some time on her stomach when she’s awake. The AAP suggests, “A certain amount of tummy time while the infant is awake and observed is recommended for developmental reasons and to help prevent flat spots ….” Babies should be strictly monitored when they’re on their bellies, Dr. Willinger cautions. “What you don’t want to do is put babies on their stomachs in the crib and walk away,” she says. (Read more about tummy time specifics.)

Tummy Play. Certain toys will encourage infants to spend more time on their tummies. There are several such toys on the market. A play quilt, a play mat, or a plastic mirror will keep an infant entertained and on his tummy.

Head Repositioning. By alternating the sides of the head on which a baby rests, parents should be able to avoid asymmetric infant heads, Dr. Butler says. The techniques the AAP urge include putting a baby to sleep with his head facing one way for one week and then turning his head the opposite way the following week.

Rearrange Baby’s Toys and Crib. Once a baby is 5 to 6 months old, trying to keep a child’s head in one direction “gets tricky,” Dr. Butler says. He suggests parents periodically rearrange toys attached to the crib, like overhead mobiles, to draw the child’s attention in another direction. For babies who like to face the door in anticipation of seeing their parents, Dr. Butler says the crib could be moved to different areas around the room.

Velcro Pillows. If a baby still rests his head consistently in one direction, Dr. Butler said he’s seen parents put little Velcro pillows on the back of a child’s pajamas to prompt the infant to face a certain way.

For children in daycare, Dr. Willinger says parents should clearly communicate to caregivers that they want their babies to have monitored tummy time while awake and to assure that the infants aren’t placed in the same position all the time. By the time a baby begins to sit up on her own, Dr. Butler says, the head will gradually round out. “No matter what you do, the head will start to improve.”

Are Helmets Necessary?

The need to have infants wear molded helmets, which look like small bicycle helmets, to reshape the head is uncommon, says Dr. Butler. A frequent reason many babies are outfitted with helmets—which are costly and not typically covered by insurance—is because their parents are uncomfortable with the appearance of their child’s head.

“Parents love their children and want to do everything to help them,” he says, adding that he has yet to see a convincing study showing that helmets, worn for up to 18 hours a day for several weeks, reshape heads better than simple repositioning does.

“People can get nutty about this,” echoes Dr. Willinger. “You have to be practical.”

Even if a baby develops a slight flat spot, Dr. Butler stresses that having an asymmetrical head does not affect a child’s neurological development; it’s merely a cosmetic condition that will likely resolve itself.

If your child does develop a flat area on her head that does not respond to simple position changes, you may want to ask your pediatrician to look into corrective measures to promote a rounder appearance. The measures can include wearing a corrective helmet.