Parents may expect the baby to have a smooth round head, the cutest little bald bulb until the baby grows some hair.
But a skull can take many shapes, especially in the baby's first few months. That's a good thing because a more flexible skull allows the baby to travel through the birth canal. The bad news, though, is that your baby's skull can also take a shape that isn't the best.
Flat head syndrome can happen to baby's in the first few months, and it's happening more and more in the last few decades. About a quarter of babies develop the issue these days. While some can get better on their own, some need a little bit of help.
A lot of time that means spending the majority of the hours of the day in a helmet. Many parents make the best of the situation by fashioning the helmets to suit their child's personality or some of their favorite costumes. Entire Etsy companies and Pinterest pages are devoted to decorating a little one's helmet.
Almost all can be treated successfully, if you know what to watch for and what to do.
To help you understand the issue, here are 16 things to know about flat head syndrome.
16 How A Skull Is Shaped
When your baby is born, the skull is made up of several plates that have a couple of spaces in between. Your newborn has two fontanels, or soft spots. One is at the top of your baby's head and there is a smaller one at the back of the head. Those spots are there so that the baby's head can be molded to get through the birth canal. It also allows room for the brain to grow, which happens very quickly at the beginning of life.
Your newborn could be born with a pointed head that looks like he is from the Conehead family from Saturday Night Live fame. But the baby's head will reshape itself within a few weeks to look more normal. That's good news for babies whose skull becomes flat a few months later. But the fontanels start to close at 6 months and your baby's skull is permanently shaped by 18 months.
The very name of the syndrome demonstrates how long it has been around. Plagiocephaly is a Greek work that means slanted skull. It has happened for centuries, although it was become for more common in the last few decades.
It can happen for a number of reasons, including a number of congenital conditions. Some of the sides include assymetry for the face and even misalignment of the ears. The top of the head will slope more on one side than the other, and the forehead may be bulging out.
There are several other kinds of flat heads that could happen to your baby, and the type could help determine the cause and even the treatment. Doctors are well-versed in the differences, and they may even notice something that you don't.
14 Other Types
Plagiocephaly is the most common of the abnormal head shapes that can happen to newborns, but because the shapes are caused in many cases by repetitive time in one position, the exact outcome can be different for many.
Brachycephaly is when the back of the head is flat, but the head ends up wider and taller than normal. It ends up more cylindrical than spherical.
An extreme version of that is scaphocephaly, where the head is narrow and long and the forehead takes on kind of square shape. This mostly happens in preemies who spend time in the Neonatal Intensive Care Unit.
All of these take on a bit of a different character, based on the position that your baby tends to prefer. So two babies with plagiocephaly could have very different shapes to their heads.
13 More Than Appearance
There is no doubt that flat head syndrome is about appearance. It is about making sure that your baby's head is correctly shaped before the bones of the skull fuse together and it becomes permanent.
But on many levels, it isn't just about appearances. If your baby has a preferred side that he always tips his cheek to when he is lying on his back, then the head can compensate to make sure that side is most comfortable. And then, pretty soon, the neck also takes on that preference and the neck muscles be stronger on one side than the other. Imagine trying to drive if you can't turn your neck to check your blind spot, or trying to hit a baseball or a tennis ball without the ability to turn your head.
It could also eventually mean that parts of the brain are pinched or don't have the right shape, although its unclear if that could hamper function. It could be a bigger deal in the long run, so it is important that your doctor does your best to get ahead of the issue before the skull is fully formed.
12 Early Beginnings
We mentioned how some babies are born with cone-shaped heads, but some show other signs of flat head syndrome at birth. Sometimes that can be because of congenital conditions that involve plysical deformities. But other times, the cuase is for similar reasons than the kind that manifests itself later on in the baby's life.
It's about the position of the baby and whether or not there are any pressures on the head during developmet. Of the babies that are born with plagiocephaly who are not facing a congenital disease, the most likely reason is the pregnancy involves multiples. The baby's siblings could be putting pressure on one point in the head more than others. A small uterus could hamper the expansion of the skull, and if the baby is positioned by the pelvis, there could be an extra strain that causes the misalignment issues.
Any time the head faces pressure — whether within the room or without — there is a risk of developing flat head syndrome. But the options are the same no matter the point when the issue is discovered.
11 Neck Muscle Tightness
Some babies are born with a condition that causes their neck to be stronger on one side than the other. Torticollis, which means "twisted neck," can be caused by issues in the development of the bones of the neck or the muscles, which can happen due to the position in the uterus or damage from the delivery.
Doctors or parents often notice pretty early on, if your baby has limited movement in the neck. Sometimes, there's a bump on the neck too.
Because your baby's neck directs her head, babies with torticollis often develop flat head syndrome. The reverse can also be true; if your baby continues to favor the same side of the head, the muscles can end up shaped that way.
For issues related to the neck muscles, there are a variety of terapies involving stretching and positioning that can help. Babies with bone issues may need other interventions so talk to your doctor.
When your baby is born, his skull is in seven pieces. That isn't because the bones were broken in labor. In fact, it is because of the delivery through the birth canal that the bones start out in pieces in order to give safer passage.
There are several sutures, or joints, which are composed of a fibrous tissue, that hold the pieces of the skull together for the first couple of years. They help to protect the brain while giving the ability for the skull to stretch and shape itself. But sometimes, those parts fuse together early, and that can be a big problem for your baby's skull shape.
Craniosynostosis is the term for when the bones fuse together too soon, and that can happen in part or in whole. It sometimes is present at birth, and you can notice a strange shape right away. Sometimes a hard ridge forms along the suture lines, or the baby's fontanel, or soft spot, disappears.
Your doctor usually picks up on the diagnosis early, and he will probably be aggressive about making sure the skull is shaped early on.
The biggest issue with craniosynostosis is that your baby's skull won't be able to grow with his brain. It can be caused by a variety of genetic and environmental factors, and in some cases it can be fixed surgically.
Craniosynostosis is very serious, and it is definitely more than a cosmetic issue. Because of the connection to brain development, it is linked to development delays and eye movement disorders, as well as cognitive impairment, seizures and blindness. In some cases, it could even mean death.
There are many different ways that the skull can fuse early, and the most common can cause the skull to be long and narrow. Be sure to talk to your doctor about what it could mean for your baby and figure out the best way to treat the issue before it is too late.
8 Back To Sleep And SIDS
Most of the cases of flat heads these days are related to the baby's position, and that is mostly because of the realization in the early 1990s that Sudden Infant Death Syndrome could be reduced if the baby is put on his back to sleep. Some very young babies could be smothered in their sleep if they cannot lift their head when their nose or mouth are down into the mattress when they sleep.
And while the "back to sleep" mantra has caused a great reduction in the number of babies who die from SIDS each year, it has also caused an incredible increase in the number of babies who develop flat head syndrome. In fact, the numbers have quintupled in the past two decades.
Sometimes, when babies sleep on their backs, they prefer to let their head drop to one side or the other. If there is reputation for one position, that can cause the head to become misaligned. It's an important issue to watch out for, but it isn't worth the risk of putting your baby to sleep on his stomach. There are other ways to fix your baby's head shape that doesn't put his life in danger.
7 Tummy Time
Just because the back is the safest position for your baby to sleep in doesn't mean that your baby should always be on her back. In fact, if your baby is having a flat head issue, you should probably try to keep him off his back at any other time.
Most moms and dads learn about tummy time when they are still in the hospital or at the very first trip to the pediatrician. That's because it is very important for the baby's development — and it is also a great way to get the pressure off baby's head.
You should make tummy time an important part of your baby's routine as soon as possible — just as soon as your baby's umbilical cord stump falls off. It helps your baby strengthen the muscles in her back and neck, gives her a new perspective and allows her body to learn new skills, with the added benefit of giving your baby's head a break.
By the way, if your baby seems to hate tummy time, she isn't alone. Most babies cry through their first several weeks of tummy time, but that just gets them moving and stretching more. Get on the ground with your little one and make a game of it. And just think of the beautiful round head in your baby's future.
6 Other Position Changes
We know that your baby may have a favorite side that she turns her head to during naps, but you can help break her from that habit. Try laying her head down in a different direction in the crib each night. Move a mobile or a lamp that attracts her attention.
Alternate sides when you feed your baby. That can come more naturally for a breastfeeding mom, but its just as important for bottle feeding so the pressure on baby's skull is evened out.
And while your baby may love to sleep in her swing or special baby seat, don't encourage that. It could become a habit to hold her head the same way, and it could mean that the same spot is getting pressure and flattening out.
Your doctor will likely talk to you about positional changes if your little one is showing signs of flat head syndrome. For some, physical therapy in the form of neck and back exercises may be prescribed. Pay attention to all of the ways that your baby naturally sits her head and try a new way. It may be hard to break the habit, but it'll be worth it when the skull returns to a normal shape.
5 Helmet Head
For the babies who have the most severe forms of flat head syndrome, a baby helmet could be the best way to reset the shape.
Known as a cranial orthotic, the helmets — or you can try a headband — are custom shaped and fitted to with a 3-D image of your baby's head. Often, they have to be worn for 23 hours a day for months at a time. It may seem like a pain, but it usually doesn't bother the baby, and it can do wonders in reshaping the skull,
Some parents can have problems with getting insurance to pay for the helmet, which can cost up to $4,000, but you should be persistent and point out that it isn't just a cosmetic issue.
Research has proven that the headgear works best if it is started at about 6 months, and if you wait until your baby's first birthday, you may miss the window for the best results.
We mentioned that cranial orthotics are custom fitted for your little one, but parents have taken pains to customize more than the fit for their little ones. Since the helmet or headband will be a major accessory pretty much all day for months, many moms and dads have worked to dress them up a bit. It isn't required, but it could be fun.
If you check out Pinterest, you can find hundreds of pictures of creative upgrades to baby's helmet. From stickers with your baby's names or initials to some really elaborate paint jobs, you can transform your baby's medical device into an inspiring art piece or fashion accessory. Make him a little biker or an aviator. Love Star Wars? How about a Storm Trooper or BB-8? Give your little princess a crown that the queen would envy or start her love of horseback riding early with an equestrian upgrade.
It may not be ideal to have a helmet during the months when you want to take daily photos of your baby's face. But if he can handle it, so can you. Make the most of it and have some fun. Those photos will be cherished, no matter what.
3 Sleeping Softly
Special helmets aren't ideal for everybody. In fact, they can be expensive and cumbersome and they require a lot of attention and follow up. Some doctors say they aren't worth the high cost and irritations that come with it — both through skin rashes and through the simple pain of having to wear a helmet all day long for weeks at a time.
There are some other alternatives that you could try for a lesser cost. There are some specially designed mattresses that distribute the weight more evenly and keep your baby's skull from feeling the pressure on one spot. They may be worth a try if you are looking for an alternative to the helmet.
However, pay attention to the timing. If you have time before the six-month mark, give a mattress a try — on top of the tummy time and therapy. But be sure that you don't miss the window before your baby's skull is more set.
2 Premature Pressure
Positional Placiophagy is very common in premature babies, which makes sense since they spend a lot of time growing and developing in a hospital incubator or baby bed. All of that time on a flat surface often creates a flat spot on the head, although it doesn't necessarily stay there.
NICU cribs are pretty hard, and premature skulls are especially malleable, which is the perfect combination for flat head syndrome. In some hospitals, nurses are more attuned to others about changing baby's position, although that can change daily based on how busy the NICU is. And babies who spend more time being held by their parents or nurses are better off.
Some parents or nurses use a rolled up burp rag to help keep the pressure off, although you need to be careful about adding anything that could suffocate a baby.
For NICU babies, there are often other challenges that take much more attention than the skull shape. Luckily, they have time to grow and heal before you have to worry about the shape of the head.
1 Wait And See?
As we've mentioned several times, your baby's skull is designed to change and grow from his birth through the first two years of life. There are good reasons for that, and the good news is that it usually means there is time to shape your baby's head if a problem develops.
Some parents prefer to take a wait and see approach for a baby with flat head syndrome. If you practice good positioning methods, hold your baby a lot and be sure to have a lot of tummy time, then it your baby's held will likely reshape on its own, as long as there are no genetic factors at play or craniosynostosis.
Be sure to talk to your doctor, so she can help you rule out any of the big issues. You should also pay attention to the timing. Often times the symptoms of flat head syndrome show up when the baby is around two or three months old, and that can leave plenty of time for a natural reshaping by his first birthday. But if you wait too late, it could become permanent.
The good news is any minor misalignments are usually unnoticeable by the time your baby's hair comes in. And flat head syndrome is usually just a minor blip in a baby's life.