During the last 10 years we have seen a steady increase in delayed milestones in infants.  The increase in children whose heads are flattened also continues to rise.  Many parents whose children are diagnosed with plagiocephaly or brachycephaly are commonly told, “it’s cosmetic,” or “it will round out on its own.” While the condition might resolve with no intervention, it could also result in delayed acquisition of developmental milestones or even more serious issues like jaw paint or sleep apnea. So, what is a parent to do?

A knowledgeable parent makes different and better decisions than a parent overrun with conflicting information from multiple sources. My hope is that this post provides important information about development and simple solutions to help your baby’s head shape. 

What causes plagiocephaly and/or brachycephaly?

Plagiocephaly and/or brachycephaly have become more prevalent in back-sleeping babies, but it is also more common with prematurity, traumatic births, multiple births or other medical issues.  A contributing factor is something called “container baby syndrome,” which refers to infants who spend lots of time in swings, car seats and other equipment to the extent that it affects development and head shape. (It’s worth noting that expectant parents are often sold equipment falsely advertised as helping baby development).

What are the complications of plagiocephaly and/or brachycephaly?

When mild, plagiocephaly will not impact later health or function. Sometimes babies also have torticollis, which is a preference to turn in one direction. There is a higher incidence of cognitive and speech issues at the age of five in children who had plagiocephaly as an infant. Later, it can result in poorly fitting eyeglasses and ill-fitting protective helmets for sports or occupations. When moderate or severe,  plagiocephaly can lead to challenging conditions for adults that include temporomandibular joint dysfunction (pain with chewing or speaking), sleep apnea and vision problems. 

What is the solution?

When it comes to development and head shape, education PRIOR to the birth of your baby is important.  Further education once the infant is born is also highly useful.  Unfortunately, this information is not readily available.  Developmentally and head shape supportive routines are not taught in prenatal classes. Most information in books, on Google, in online chat groups, or from a well-meaning day care provider, neighbor or grandparent is not sufficiently detailed or accurate.  

Look for a short class designed specifically to teach developmentally supportive routines and what equipment or toys to purchase and which to avoid. After the baby is born, go to a class on tummy time. These classes provide information on ways to hold your infant which support development and head shape, and other simple but important tips.  

Finally, lying flat or in sidelying on a blanket on the floor is truly a fantastic place for an infant when not being held.   Unless directed otherwise by your pediatrician, have your baby sleep on a flat, firm surface as recommended by the American Academy of Pediatrics.  This is the safest place as well as best for head shape and development.

My baby’s head is flat. Will she have to wear a helmet?

If you notice head-flattening or a preference to look in one direction, have your baby checked out by an occupational or physical therapist who specializes in this area. The best way to avoid a cranial band (helmet) and/or extensive therapy is to address concerns early and thoroughly. Oftentimes one session is all that is needed to thoroughly assess the underlying issue and further educate the parent on the specifics of what their infant needs. For infants with more involved turning preference or head shape, a thorough evaluation may be followed by therapy for four to 16 weeks. A cranial band to reshape the skull is sometimes recommended. An occupational or physical therapist whose caseload includes mainly infants and also has expertise with manual therapy skill (craniosacral or myofascial release) is ideal.

Susan Klemm MS, OTR/L founded Carolina Kinder Development in 2006 to prevent and treat head, neck and developmental issues in infants.  The ongoing developmental and orthopedic issues during the early years are also part of their services.