Head Shape Deformities: Many Parents Ask, “Is it MY Fault?”
Parents often feel guilty if their baby has a flat spot and/or needs a helmet; we hope to ease that guilt and reassure you: it is not your fault!
Cranial deformities have become more common and visible over the past 30ish years since the implementation of the Back to Sleep program of the mid-90s, which encouraged parents to place their baby on his or her back while sleeping in order to reduce the risk for SIDS. Some research estimates that around 45-50% of all babies of the generation since end up with some level of cranial asymmetry.
So flat spots are pretty common… but why do some kiddos have them while some avoid them? Especially if most babies are put on their backs to sleep? This article will investigate the factors that predispose a baby to a flat spot and could increase the chance of one developing. The first two are out of a parent’s control; the latter two are (somewhat) within control but by no means easy to manage.
Factor One: Intrauterine Space (or Lack of) & Delivery Method
Some babies exit the womb with a misshapen head. This is quite common and we often see the head settle into a somewhat round shape within the first four weeks of life. But some babies continue to grow with a flat spot that began in the womb. Elements of prenatal deformity are things like large fetal size, low amount of amniotic fluid, low fetal activity, prolonged time in a breech position or the head being nuzzled into the mom’s pubic bone, sharing the womb with siblings (multiples are at a much higher risk of developing a flat spot), or delivery mode at birth where there was a long pushing phase or need for tools like a vacuum or forceps.
Intrauterine Space: out of your control!
Related: Which Babies Are More Likely to Need a Helmet and Why?
Factor Two: Torticollis
Torticollis is one-sided neck tightness (but it impacts the whole body). This is the most widely acknowledged type of muscle imbalance associated with a flat spot. Torticollis begins in the womb (see many of the factors listed above) and can be difficult to resolve after birth. When one side of the neck is tight, a baby develops a preference to look to one side, which means they often spend their time on one side of their head when sleeping. This consistent pressure on the super-pliable skull leads to a flat spot. The flat spot then perpetuates the preferred head placement and can lead to a frustrating cycle.
When torticollis is present, it is often viewed as the root cause of the flat spot. The flat spot is essentially a symptom of the torticollis. So true correction of the flat spot should involve treatment of the torticollis - which typically includes stretches and strengthening exercises - to ensure the one-sided tightness is resolved and does not negatively impact other motor development and milestone achievement as the baby grows. We are huge advocates for pediatric physical therapy and chiropractic care to help manage and resolve torticollis.
Torticollis: the development of it is out of your control, the treatment and management are not!
Factor Three: Back Sleeping & Containers
The reality of our time is that families are busy. And advancements in technology and manufacturing have allowed parents to adapt to living productive, efficient lives by offering various “containers” for babies to be safe, comfortable, and present as they do all they need to do in a day; especially parents with older children who have activities outside of the home. An infant may be transported from the bassinet, bouncer, car seat, stroller, swing, and back to the bassinet all in a matter of a few hours. With each container comes more time spent on the back of their heads.
Further, if a baby has difficulty turning their head due to torticollis or general weakness in head or neck control, considerable amounts of pressure are then put on one side of the skull, which can create or increase a flat spot. One of our first suggestions is to prioritize variable positions throughout the day so a baby isn’t containers for more than three cumulative hours per day (reduce that to two hours or less if a flat spot is already present). We love to suggest frequent baby-wearing, prioritizing tummy time, and offering lots and lots of “free space play” - all you need is a blanket on the floor with some simple toys placed strategically to help prevent or reduce a flat spot!
Containers: in your control, butttt we understand how challenging it can be to prevent their use!
Related: Baby Gear and Flat Spots: How Containers Influence Head Shape
Related: Flat Head Syndrome: How a Flat Spot Can Get Better or Worse
Factor Four: Lack of Tummy Time
Ahh, tummy time. Some babies love it, others… not so much. The benefits of tummy time are plentiful: increase neck, trunk, and arm strength to progress milestone achievement and meet developmental markers; encourage sensory development and integration; bonding opportunities; and, of course, prevent or reduce the progression of a flat spot.
Tummy time is sometimes as simple as placing a baby on their tummy on the floor. But for others, it can come with fussing and fighting that makes parents (understandably) call it quits after a few seconds. For some babies, tummy time is uncomfortable because of gas or reflux, torticollis and tension in the muscles that create discomfort with extending the body, or frustration with the inability to sustain positions for long.
Read this: Let’s Talk Tummy Time: How to keep your baby happy on their belly
Something that most parents don’t realize is that there are many different ways to get the benefits of tummy time outside of the traditional technique. Some alternative positions include: placing your baby on your chest while lying on a recliner or the floor, propping their body on a wedge or boppy pillow, or placing them over your knees so they have a bit more control over what they are looking at.
If your baby is really struggling with tolerating tummy time, it would be beneficial to see a professional who can help assess for underlying issues and help problem solve different ways that offer the same benefits. We offer this type of training in our Milestone Assessment - click here for more information.
Tummy time: can be difficult, but there is help!
My Baby Might Have A Flat Spot… Now What?
If you have any concerns about the shape of your baby’s head, please reach out. We offer a variety of services to help determine the best plan of action for your little one. You can check out our services here and schedule your appointment via our online platform: Baby Bear Cranial Clinic Scheduling.