Is It Normal for a Baby to Have a Flat Head?

I once overheard a conversation at the park between a father and his friend. The friend had commented on the shocking distortion of the baby's skull-- it was completely flattened in the back, to the point that there was a straight line from the baby's neck to the top of his skull. The father explained nonchalantly that it was "completely normal" and that "all little babies have that because they sleep on their backs."

I looked at my daughter as he said that. She was roughly the same age-- about two months old-- and the back of her head was perfectly contoured, with the same amount of hair as the rest of her scalp. Although common, a flat head on a baby, known clinically as plagiocephaly, is not "completely normal," and it is reason for concern. If your baby has a flat head, here are some points that you need to consider.

1. It may not just be a cosmetic problem. In 2010, CBC news reported that babies with plagiocephaly seem to be at a significantly higher risk of learning disabilities. This may be because the deformation of the skull actually impacts the growth and development of the baby's brain. Alternatively, it may be because plagiocephaly is sometimes symptomatic of neglect, and that babies who are not held regularly tend to leg developmentally.

2. You probably need to hold your baby more. Babies are not made to spend hours on end inside bouncers, car seats or swings. They should spend almost all of their waking hours in the loving arms of a caregiver. If your baby has significant plagiocephaly, it is a sign that he is not getting as much attention as he needs. My daughter's pediatrician recommends that babies spend no more than half an hour per day total in bouncers, swings or car seats.

3. Change your baby's position. Your baby shouldn't be lying down all, or most, of the day. If you aren't holding him, try giving him a few minutes of supervised "tummy time"-- which takes pressure off the back of his head and also gives him an opportunity to exercise his arms and legs. Also try alternating the position in which your baby sleeps. Side-sleeping is considered just as safe as back-sleeping, but never let your baby sleep on his stomach.

4. Your baby may benefit from physical therapy. Talk to your baby's pediatrician about his flattened head. Several simple exercises can be done at home to gently and painlessly increase strength and mobility of your baby's neck muscles. This can help to prevent your baby from involuntarily keeping his head in the same position for extended period of time. This treatment is necessary for many babies, and can help to prevent the need for more major interventions.

5. Without effective prevention and early treatment, your baby may need major medical treatments. If you don't effectively prevent and treat your baby's flattened head, he may require cranial orthotic therapy. This involves the use of a specialized helmet worn for at least 23 hours per day, for about six to twelve months. Cranial orthotic therapy is very expensive, but often necessary to prevent permanent deformation of the skull.

If you are concerned about your baby's flat head, get in touch with your pediatrician. While many cases of plagiocephaly do self-resolve without specific intervention, it is important to pay attention to this symptom and seek effective treatment.