According to the American Academy of Family Physicians, about 50% of babies will develop Flat Head Syndrome, also known as plagiocephaly or brachycephaly. The most common cause of head shape issues is the way an infant’s head is positioned during pregnancy, birth, or infancy (Thirteen Factors that Can Contribute to Flattening of a Baby’s Head). Research supports that approximately two-thirds of infants with head shape flattening and/or neck issues (plagiocephaly, brachycephaly, torticollis) will improve or resolve by 2 years of age.  What this means, however, is that one-third of infants with head shape issues will not improve by 2 years of age. 

In respect for the fullness of this statistic, we share that we have parents bring their 2-, 3-, or 4-year-olds into our clinic in hopes of improving head shape issues that did not resolve on their own, given time.  Sadly, after approximately 18 months, cranial banding (aka helmet therapy) is not effective and is not an option. While some manual therapy techniques, such as craniosacral therapy (CST), can help to address symptoms related to head shape issues, cranial surgery would be the only remaining option.

It is not unusual for parents of these children to report that they pointed out the flattening to their pediatrician and at times also had an appointment with a specialist such as a neurosurgeon.  They were given reassurance that by 2 years of age, most children’s head shape issues will have resolved without a cranial band/helmet.  These families unfortunately fall in the 1/3 of cases for whom the plagiocephaly and brachycephaly did not improve on its own.

Please note that many studies illustrate that early infancy is the optimal and most effective time to resolve neck and head shape issues through therapy and if needed –and only if needed– cranial band or helmet therapy. 

At Carolina Kinder Development (CKD), our approach is to educate parents so they can make decisions about what is best for their child and family.  When a highly specialized physical or occupational therapist intervenes as soon as a neck and/or head shape issue is noted (which can be as early as one to three weeks old) the issues can often quickly resolve.  Quite often only one to two sessions are needed!

In the initial evaluation, our therapists thoroughly assess the head shape to establish baseline measurements from which we can assess progress as the infant grows, as needed.  We also use gentle, hands-on techniques to help resolve the muscle imbalances that are frequently seen in conjunction with head shape issues.  A significant amount of time is spent on detailed parental education for developmentally supportive routines specific to their infant.   

A proactive approach to neck and head shape issues is ideal; it is far more desirable to prevent an infant’s head shape from worsening early on than to later attempt to restore what once was. 

Time and time again, parents express gratitude to our therapists for the opportunity to proactively address their concerns about their child’s neck and/or head shape issues, rather than watching and waiting to see if these issues will end up improving on their own, or not.

While Google is a great source of general information, it is best to talk to your pediatrician or a pediatric occupational or physical therapist if you have any questions about your baby’s head shape or development.  Questions or want to make an appointment?  Please reach out to us at 704-379-7773 or [email protected].

Susan Klemm MS, OTR/L and Stacy Conder, PT