head, flat (plagiocephaly)

The head of a young infant that appears flattened in one area can have one of several causes:

Flattening of the head behind the ear due to habitual right-side sleeping or sleeping on the back (supine) with the head always toward the same end of the crib (plagiocephaly - pla-gee-o-SEF-a-lee). This is cured by alternating the baby from night to night - head to the right, head to the left, head to the right, etc.
Flattening purely on the back of the head is also usually positional - the child who lies in the crib or playpen all day
Other elongations or deformation of the head shape could be synostosis (sin-os-toe-sis) which is abnormal, premature growing together of the normally separate plates of the skull in an infant. This should be checked by your doctor and possibly a specialist.
Plagiocephaly or flat head can also be a sign of torticollis, especially if the signs include include not only a flattened back of the head but a more prominent forehead, a flattened ear on the affected side, asymmetry of the jaw with an upward slant on the same side as the torticollis, and facial asymmetry, with one cheek appearing fuller than the other.

Parents should first and foremost pay attention to two details. First, our new slogan is "Back to sleep, tummy to play." Babies should definitely sleep on their backs, but when awake and supervised 100% by the parent, should be allowed to play on their tummies. Do not leave young infants unattended on their tummies, even to answer the telephone. Second, pay attention to sleep positioning - let the baby sleep half the nights with the head one way, half the nights the other way - until the child is mobile in the crib and rolling around. This simple approach is in my experience sufficient to prevent any significant skull asymmetry.

The use of helmets to correct or prevent simple positional plagiocephaly in babies caused by back sleeping was once somewhat controversial but is no longer. These devices have been shown to be effective for babies in whom positioning therapy has failed, and at least one is approved by the FDA. They should be prescribed under the supervision of a pediatric neurosurgeon.

Management of deformational plagiocephaly: repositioning versus orthotic therapy. Graham JM Jr - J Pediatr - 01-FEB-2005; 146(2): 258-62

Deformational brachycephaly in supine-sleeping infants. Graham JM Jr - J Pediatr - 01-FEB-2005; 146(2): 253-7

Skull deformities. Ridgway EB - Pediatr Clin North Am - 01-APR-2004; 51(2): 359-87

Diagnosis and management of positional head deformity. Biggs WS - Am Fam Physician - 1-MAY-2003; 67(9): 1953-6

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