Does your baby’s head have a Flat Spot?

Here's Your Guide to Plagiocephaly

As a Mum to a new baby, everything feels high-stress regarding our beautiful newborn's health. So, if you've noticed a flat spot on your baby's head, take a deep breath, it’s ok – let us talk you through what is happening and some of the things to consider to support your little one.

No doubt your googling journey has started and that is how you ended up here! It’s important to shift any panic or worry you may be feeling to experiencing empowerment through education. We're here to help you build your knowledge to confidently make informed decisions. 

There are a few different ways to describe the change in head shape or development of a flat spot. The medical term for this condition is "plagiocephaly." 

Our goal is to help demystify plagiocephaly, explaining its causes, and types, and most importantly, equipping you with the knowledge you need to navigate caring for your baby confidently.

What is Plagiocephaly?

Imagine your baby's soft skull as beautiful, moldable clay. Plagiocephaly means that one head area has become flatter and our cranial shape is no longer symmetrical. In other words, the soft cranial shape has distorted. This often happens due to mechanical forces in the womb, during birth or postnatally. 

It is quite common for babies to have some minor changes to their head shape at birth, but this usually corrects itself in the early weeks after birth. Positional plagiocephaly refers to babies older than 6 weeks with a persistent or new head shape asymmetry. 

There are two main types of plagiocephaly:

• Positional plagiocephaly: This is the most common type, caused by a baby's restrictions leading to a persistent head position.
• Craniosynostosis: This is a rarer condition where the skull sutures (joints) close too early, restricting growth. This usually causes a more severe head-shape abnormality.

Studies suggest plagiocephaly affects roughly one in four babies , with some variations depending on risk factors [1]

But What Caused This?

There are multiple things that can contribute to the development of a flat spot. 

In 1994 the Back to Sleep campaign highlighted the importance of sleeping babies on their back (supine) to prevent SIDS. Although supine sleeping is incredibly important at night, it has made many parents fearful of safe tummy time during awake periods, limiting the variety of movement babies enjoy during the day. 

Some babies love looking towards a particular side because something piques their interest. Often turning towards light from a window or Mum and Dad if sleeping in the same room. Again, this lack of variety can be a contributing factor. 

Another factor we see repeatedly in practice is restriction and discomfort through the neck and shoulders. This limits the full range of motion, leading to turning the head one way to avoid the discomfort felt going to the restricted or inflamed side. 

Other factors that can contribute to plagiocephaly include:

• Torticollis: This is a condition where a baby's neck muscles are tight, limiting their head movement and making them prefer one side.
• Premature birth: Premature babies often have softer skull plates, making them more susceptible to head shape changes. 
• Multiple births: Twins or triplets may have limited space in the womb, potentially affecting head shape.

It's important to remember that a flat spot doesn't mean you're doing anything wrong, and it's not a reflection of your parenting skills. It can also change from mild to more severe quite quickly. Many parents are tough on themselves about not noticing earlier, but it can be very subtle to begin with and hard to spot. 

Signs and Symptoms to Look For:

• A visible flat spot on the back or side of the head
• An ear that appears more prominent on one side versus the other
• Persistent head tilting or rotation 
• Difficulty turning the head fully in one direction (might indicate torticollis, a tight neck muscle that can contribute to plagiocephaly)

Early detection and intervention are important. Positional plagiocephaly was once considered a purely cosmetic concern. We now understand that it’s not quite as simple as ‘normalising’ cranial shape with recent research suggesting that developmental difficulties with movement and learning may require intervention during the primary school years (3). Therefore supporting and monitoring children through infancy and beyond for developmental outcomes is an important part of a comprehensive approach. 

 If you suspect your baby might have plagiocephaly, Paediatric Chiropractors are one of the several health professionals trained to review, measure, and support your baby's health outcomes. By taking measurements and images, we assess severity and recommend appropriate care plans, with regular intervals of re-measurements and photos to monitor progress closely. This, combined with monitoring developmental milestones, paints a clear picture of progress and helps parents feel confident about their baby’s care and longer-term outcomes. 

Research shows gentle, non-invasive management is sufficient for most cases of plagiocephaly. However, in more severe cases, a specially designed helmet may be necessary to guide head shape correction gently. This should then be combined with developmental support if/where needed.

Okay, So What Can You Do At Home?

Here are some easy, non-invasive ways to encourage a more symmetrical head shape:

• Be A Repositioning Rockstar: Become a pro at repositioning your baby head at night to encourage pressure on the fuller side, and off the flat side! 
• Ensure Variety In The Day: During awake time, encourage your baby to turn their head to the fuller side by placing toys, light or ensuring the window encourages head turning. 
• Tummy Time Champion: Tummy time is very important for building muscle tone, supporting spinal development and helping babys with plagiocephaly! It strengthens neck muscles and promotes head shape symmetry. Start slow with short bursts under your watchful eye. Come along to our Tummy Time Workshops HERE for more information!

How can the Chiropractors at ACCC help?

As chiropractors, we can play a supportive role in managing plagiocephaly. Here's how:

• Early detection: with our special focus on paediatrics, our chiropractors can assess your baby's head shape and identify any asymmetry during routine checkups. Early detection is key for effective management. 
• Torticollis management: If tight neck muscles contribute to your baby's plagiocephaly, gentle stretching and mobilisation techniques can help improve neck movement and head-turning ability, aiding in head shape correction.
• Repositioning guidance: Our chiropractors can offer guidance on specific repositioning techniques, stretches, and exercises for your baby to encourage symmetrical head development.
• Monitoring developmental milestones: We measure and monitor the big and small milestones to help parents feel confident every step of the way. 

The Takeaway:

Plagiocephaly can be a common concern. With early detection and some simple strategies, you can help your little one build strength and improve their range of movement. At ACCC, we're here to support you on your parenting journey, and together, help your little one through every stage of their life!

References:

1. Loderer, A. C., & Davis, R. A. (2011). Positional plagiocephaly and brachycephaly in babys. Pediatrics, 128(6), 1146-1152. https://www.ncbi.nlm.nih.gov/books/NBK564334/
2. Mayfield, S. N., Cooper, D. M., & Cartwright, C. D. (2015). Neurodevelopmental outcomes in babys with nonsyndromic positional plagiocephaly treated with corrective helmets. The Journal of cranial-facial surgery, 28(6), 1422-1428. [invalid URL removed]

Bialocerkowski, A.E., Vladusic, S.L. and Wei Ng, C., 2008. Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Developmental Medicine & Child Neurology, 50(8), pp.577-586.