What is flat head syndrome?
Flat head syndrome (or plagiocephaly) is when the back of a baby's head develops a flat spot as it grows. It can sometimes also create a bulge on the forehead and facial features can become asymmetrical (e.g. some babies might have one ear further forward than the other).

You may not notice the flat spot when you look at your baby front on. The asymmetry may be more noticeable if you compare your baby's left and right profiles. If there is lopsidedness it is most obvious when viewed from above - looking down on the top of your baby's head.

Why does flat head syndrome occur?
Newborn babies have a very soft skull and prolonged pressure on the one spot can cause a flattened area to develop as they grow. This means their head can become flat or misshapen if they are constantly lying on the same area of their skull.

The incidence of flat head syndrome has increased from 1 in 300 in the 1970s to 1 in 10 today.

This is likely to be because more parents put babies to sleep on their backs as recommended by Sids Safe Sleeping.

How do I prevent flat head syndrome?
1. The first step in preventing flat head syndrome is to alternate your baby's head position each time they sleep. You should always follow Sids Safe Sleeping Guidelines and place baby on their back to sleep. But when you put them down you should take note of which way their head is turned and then next time turn it to face the opposite way. A young baby spends a lot of time asleep and if they are always lying on the same spot their head will not grow symmetrically - a flat spot will develop.

2. If your baby shows a preference for facing a certain direction take note of the way the nursery is laid out. Babies tend to look to the centre of a room or towards the doorway. You might have to change the way the cot faces or alternate ends of the cot each time you put baby to sleep.

3. If the preference is unrelated to your nursery layout (ie baby looks to the left every time regardless of how often you reposition their head/move the furniture) see your GP or child health nurse. They may refer you to a physiotherapist to rule out a physical reason for the preference (eg. muscle tightness in the neck).

4. Tummy time: It is important that babies sleep on their backs. And it is also important to give them plenty of supervised tummy time when they are awake. Tummy time will help develop your baby's neck, shoulder, arm and back muscles. It will also help reduce the chance of your baby developing a flat spot as it gets them off the back of their head. See Tips for making tummy time fun

My baby has a flat spot! Can it be fixed?
A baby's head grows a lot in those first few weeks and sometimes a flat spot can develop without the parents realising, or in spite of all repositioning efforts.

Do not fret - if your baby is still growing it is possible to correct a flat spot.

First of all talk to your GP or child health nurse and ask them to assess the flat spot or refer you to someone who can. They can measure your baby's head and give you an idea as to whether the flattening is mild, moderate or severe.

Consider seeing a physiotherapist if your baby has a preference for looking to one side. They can help identify muscular issues, can give you exercises to help improve your baby's range of movement and show you some tips on making tummy time fun.

Reposition, reposition, reposition. If your baby has already developed a flat spot then it is important to keep them from lying on that spot as much as possible.

Sleeping: Try to make sure they aren't sleeping on the flat spot - which is more difficult once it has started to go flat (imagine a ball with a flat spot, if you roll it down a hill it will always come to rest of the flat area). Change the nursery around so all the exciting stuff is on the non-preferred side. If they go to sleep lying on the flat spot turn their head the other way once they are asleep.

Awake: Give baby plenty of tummy time in a variety of positions (in the bath, on your chest etc) and make tummy time fun by playing with baby in this position. Consider putting a mobile on the non-preferred side of the change table. Always talk and play with baby from the non-preferred side and encourage others to do so too (eg, when people poke their head into the pram to talk your baby guide them towards the non-preferred side). Put baby down for supervised play on their side and always put toys (or yourself) on the non-preferred side.

Feeding: If you're breastfeeding your baby try the football hold for the side that normally has them lying on the flat spot. If bottlefeeding, make sure you always feed so the baby is not resting on the flat spot.

Will my baby need to wear a helmet?
Cranial remoulding helmets have been used to treat plagiocephaly since the late 1980s. They are usually made out of a non-allergenic foam lining with a polypropylene outer layer. They work by leaving a gap where the flat spot is - this encourages growth into that gap while also ensuring the baby is not lying on the flat spot.

The helmets are most effective when fitted while a baby's head is still growing quickly -usually between four and seven months old. Usually the quicker the head grows the less time is needed in the helmet.
Health professionals might recommend a helmet for your baby if the flat spot is severe or moderate and if attempts to reshape the head using repositioning techniques are not working - especially if the baby is approaching six months old.

A baby's head will naturally grow into a more correct shape as they get older and become less likely to spend their days lying on their backs. But the amount of improvement will depend on how old the baby is when you start using repositioning techniques, the severity of the flat spot and how well repositioning techniques are implemented.

And, of course, it is your decision whether to go ahead with the helmet or not.

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