What You Need to Know: Flat Head Syndrome

Category: Newborns

The American Pediatric Association recommends that babies be put to sleep on their back. But how do you keep them safe while preventing flat head syndrome? MH asks the experts.




A baby's head is rarely round after birth. It might take a day of two for the baby's skull bones to mould into shape. Flat-head happens when the baby has been lying mainly on the back hence leading to the flattening of the back of the head. It is thought that flat head syndrome is more common in today's society. The good news is, this is usually not a permanent condition.


The Importance of Sleeping on Their Backs

It is important for babies to be put to sleep on their backs to prevent Sudden Infant Death Syndrome (SIDS). However, to prevent flat head syndrome, avoid prolonged pressure on any part of the head by repositioning when sleeping, explains Dr Guadalupe Viegelmann, senior resident, Department of Neonatal and Developmental Medicine, Singapore General Hospital.


What is Flat Head Syndrome?

Babies’ skulls are made of soft, malleable bones. Lying in the same position for prolonged periods of time can lead to flattening of the back or side of the head. This flattening is called positional plagiocephaly (flat head syndrome) and is usually seen after six weeks of life, says Dr Viegelmann.


Is it a permanent condition?

Most cases of flat head syndrome are mild and improve naturally as the baby starts to lift her head up more. However, once the skull bones have hardened, the flattening is permanent, explains Dr Viegelmann.


Which babies are likely to develop Flat Head Syndrome?

According to Dr Viegelmann, a baby might start to develop flat head syndrome before birth, if pressure is placed on the baby's skull by the mother's pelvis or a twin. Premature babies have softer skulls and tend to turn less. Babies with tight neck muscles will tend to keep their heads turned to one side (torticollis), causing flattening on the side they are lying on.



Babies who spend long periods of time lying in the same position will be more likely to develop flat head syndrome, and placing babies in devices (infant car seats, carriers, strollers, swings, and bouncy seats) where they lie down often during the day also adds to this problem.



How can you tell if your baby’s head flattening is severe or not?

There is currently no international standard system to classify the severity of positional plagiocephaly. The assessment of severity is typically based on clinical judgment. Mild cases are associated with flattening restricted to the back or side of the skull; moderate cases are associated with malposition of the ear or the presence of deformity of the forehead on the same side as the flattening. Severe cases may have additional cheek, face and jaw asymmetry on the same side as the flattening.

The flattening is severe when there is uneven growth of the face or there is development delay. Your paediatrician will be able to assess the severity and guide you accordingly, explains Dr Lee Le Ye, consultant, Department of Neonatology, National University Hospital.

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