What Parents Need to Know about Flat Head Syndrome

Pediatric neurosurgeon Dr. Naina Gross, with The Children’s Hospital at Saint Francis, answers questions about plagiocephaly – more commonly known as flat head syndrome. Watch the video below to listen to the interview, or read the transcript.

TK: What is plagiocephaly, or flat head syndrome, and how common is it?

Dr. Gross: Flat head syndrome, or plagiocephaly, is molding of the skull due to pressure. It has been more commonly seen as infants are encouraged to sleep on their backs to prevent SIDS. When infants lie on the back of their head to sleep, they may get molding of the skull from the external force of the bed.

TK: When do parents or the child’s pediatrician start noticing the syndrome, and is it dangerous?

Dr. Gross: As early as 2 months of age. Occasionally we will have a child that is born with congenital plagiocephaly, which is molding that occurred in utero from being up against a rib or a pelvic bone. Generally, we give it a few weeks to see if the birth molding will change.

Positional molding takes a couple months. We generally will get referrals anywhere from 2 months to 10 months of age, depending on the doctor’s level of comfort or concern with the situation, or sometimes the family’s level of concern. 

TK: Is it dangerous?

Dr. Gross: Plagiocephaly is not dangerous. It is not going to cause any detriment to the child’s brain growth and development. It doesn’t put undue pressure on the brain. It’s cosmetic. 

TK: Going back to the Back to Sleep, putting infants on their backs, that is recommended for safe sleep. Is there a way to alleviate that problem? Are there things that parents can do because we do want to have safe sleep, but are there things parents can do to keep their child’s head from flattening?

Dr. Gross: During awake times, position infants so they’re not on the back of their head — what we call “tummy time.” Every newborn or infant hates tummy time initially, but they generally will get used to it, especially when they can start holding their head up and pushing themselves up. But any time off the back of the head while the child is awake will alleviate that pressure time the skull is feeling.

We often see, too, plagiocephaly on one side. If just the right side is flattening and the left side isn’t, then we recommend repositioning techniques to reduce pressure on that side of the head. For example, putting a toy on the other side when the baby is in a car seat –anything the parents can do to reposition that area of the head when the child is awake.

TK: When you see the child, are there different levels of severity of the syndrome?

Dr. Gross: Yes. There’s anywhere from just barely flat to significant flattening.  

TK: Is helmet therapy used for flat head syndrome?

Dr. Gross: Yes and no. It depends on the helmet and the circumstance. For example, there are cases of abnormal skull fusions that, after we do a surgery to release the fused skull, we put them in a helmet. It’s kind of like doing Invisalign for your teeth. We must get those bones to move, and so we will put them in a helmet after those surgeries.

Then there are plagiocephaly helmets, which are molding helmets to help reshape the skull.

It works. But, as I said, plagiocephaly isn’t dangerous to the brain or to the child’s development. It’s cosmetic. So, helmet therapy is an option. Long-term studies show no statistical difference in reshaping at age 4 between children who used helmets and those who did not. Most children’s heads will reshape with repositioning techniques. Eventually, kids stop lying on the back of their heads through natural sleep movement, so the brain pushes the skull back out into a “normal” shape. Helmets are not always a must.

With natural sleep movement, kids eventually stop lying on the back of their heads. They start flipping over in their sleep, and they start sitting up, so they’re not lying on the back of their head anymore. Then the brain takes over and pushes the skull back out into a “normal” shape.

So, helmets work. They’re not required.

TK: So, you’re saying that it’s usually self-correcting?

Dr. Gross: Yes. Usually, it’s eventually self-correcting. Maybe not 100 percent, but helmets don’t correct 100% either. Some patients still have some flatness to their head after treatment. I often tell families, “Nobody’s skull is perfect, and that’s why we have hair.”