Infant Misshapen Head

You may have noticed uneven head shapes on babies.

While head shape is largely genetic, how you position your baby when she is sleeping, resting or laying around during the early weeks and months can have an effect. This is because infant heads have several bones with pliable connections that expand as the brain grows. Couple this mouldable softness with the fact that she spends a lot of time laying on her back and it leaves her at risk of developing plagiocephalie.

Flat spots can occur in various parts of the head depending on the area baby tends to favour, which is why you may hear it called ‘positional’ plagiocephalie.  A misshapen head, if severe enough, may result in associated problems such as orthodontic and visual issues later in life.

To reduce long term effects of misshapen heads it is a good idea to have your baby checked regularly by a child health professional, particularly during the first three months when heads are easily flattened from external pressure but are also easily managed back into the correct shape. Early corrective and preventative measures are best, as between 6 and 12 months of age treatment is much more difficult and after 12 months the opportunity for correction is minimal.

Your infant may find moving her head into certain positions difficult. This may be due to pain from a forceps assisted birth or a torticollis—a congenital shortening and tightening of muscles on one side of the neck. Both these conditions will improve with time but during the healing process your baby risks a flat area developing on the head. In either of these conditions your baby may also be unsettled with neck pain when she stretches out her neck during tummy time or when she positions herself to feed from a particular breast.

Occasionally, an asymmetrical head shape is caused by the early closure of cranial sutures, the area that allows the skull to expand. This is an uncommon condition known as craniosynostosis, which requires corrective surgery and is picked up at regular child health checks. 

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Being aware of how flat areas form is important for knowing how to prevent or correct a flat head. For example, your baby may adopt the same position every time she is put down because her eyes are drawn to a stream of light coming through a crack in the door or through the curtains. She will also stretch her head in the direction where she can see you, the television or other siblings playing. If your baby is always placed in the same side of a side-by-side stroller or fed from the same side when feeding from a bottle this may also lead to the formation of a flattened area.

Even constantly having her propped up in a rocker or bouncer in an attempt to alleviate uncomfortable symptoms of gastro-oesophageal reflux can result in the skull becoming flattened at the back. Once an area on the head begins to flatten it becomes a comfortable spot to naturally rest her head but there are some things that you can do to help prevent this happening.

Start soon after birth by placing your baby at alternative ends of the cot or bassinette to sleep, while still placing her feet close to the end.

Make supervised tummy time a regular part of each wake period during the day. Increase the length of time on her tummy as she and gets older and gains neck strength. 

Side lying is also good while your baby is awake and being watched. Hold her in different ways so she sees the world from different angles (using a sling can be helpful here too).

Be conscious of her feeding positions. If you are feeding from only one breast, a mix of under-arm feeds (also known as football hold) and across-your-lap feeds is a good idea. If you are bottle feeding change the arm you feed from at some feeds. Some additional devices or a rolled cloth can be helpful in some situations to restrict her head turning to the flat spot. In severe cases of flat head syndrome in an older baby (usually 5 – 8 months old), a customised corrective helmet may be required. This is a decision made by your child health professional, physio or GP. 

Rest assured, even if a helmet is necessary it is only temporary. Your baby may not like it at first but as a teenager with a beautiful head shape and no orthodontic issues—she will thank you.

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References: Deformational_Plagiocephaly.pdf

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Jan Murray has been committed to studying and working as a Registered Nurse, Midwife and Child Health Nurse for over 25 years. Jan has a bachelor of Behavioural Science, is a mother and nanna, who co-founded and directs Settle Petal. Jan provides information and support for parents to develop their knowledge base and confidence.

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