Flat Head Syndrome

By Peter Galvin, MD

The cranial or skull bones of infants are soft and have gaps, called fontanelles, that do not fully close and fuse together until the child is about 18 months of age. Flat head syndrome is caused by prolonged pressure on an infant’s skull during pregnancy or in early infancy. There are two types of flat head shapes, although some infants may have both types. In plagiocephaly, the back of the head is flat on one side. In severe cases, it may cause the ear on that side of the head to appear to be pushed forward and/or lead to an uneven appearance of the face, neck, or jaw. In brachycephaly, the entire back of the head is flat, and the head appears wider than normal.

Flat head syndrome does not affect brain development or intelligence. Flat head syndrome is common, affecting one out of every eight healthy young infants younger than one year, although most have a mild form. Diagnosis is made by a pediatrician and is based on clinical examination. Rates of flat head syndrome increased after 1994 when a recommendation was made to have infants sleep on their backs to prevent sudden infant death syndrome (SIDS). Flat head syndrome is associated with prolonged use of infant carriers, car seats, and swings. It is also associated with multiple births, prematurity, and delayed attainment of motor skills such as rolling over or sitting up.

Flat head syndrome may be prevented by alternating the side of the infant’s head that is facing down when laying infants on their backs. It is also important to limit the amount of time an infant spends in carriers, car seats, and swings. Frequent supervised episodes of placing infants in the prone position when they are awake, known as “tummy time,” for a total of 30 minutes per day helps decrease the risk of flat head syndrome. Infants with moderate to severe flat head syndrome may benefit from helmet therapy, which reshapes the soft skull bones using a medical device that redirects normal head growth to flat skull areas. Helmets are custom made from lightweight, rigid materials such as plastic and have foam padding on the inside for comfort and to allow room for the growth of the infant’s skull. Helmet design varies based on the specific needs of an infant’s head shape. Helmets are fitted by a trained professional such as an orthotist (specialist in orthotics). Helmet therapy can be used as early as four months but no later than 12 months of age. Helmets should be cleaned daily with 70% isopropyl alcohol. Wipes, powders, or lotions should not be applied to the infant’s head or the helmet.

For more information go to the American Association of Neurological Surgeons at www.aans.org

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