Flat Head Syndrome: How a Flat Spot Can Get Better or Worse
Flat spots can seem intimidating, however, the physics of how they develop and resolve is relatively simple. This article will share the ins and outs of how flat spots form and what can be done to help correct them.
Does your baby have a flat spot? If you haven’t already, be sure to check out our posts about how to assess your baby’s head for a flat spot, how to determine which head shape your baby has, and common causes of flat spots (with reassurance that it’s not your fault!).
As we discuss in this post, there are many reasons why a flat spot develops. Whether it is from lack of intrauterine growth, muscle tightness, or high amounts of container use, the physics behind it is the same:
Prolonged contact and pressure over an area of the head in the early months of life when the skull is pliable results in reshaping of the skull.
Image from https://www.aboutkidshealth.ca/plagiocephalytreatment
Infant Skull 101
Let’s break down the graphic above.
The lines and segments on the baby’s head represent the skull bones and the sutures between them. An infant has three relevant parts of the skull that contribute to flat spots:
two frontal bones that make up the forehead,
two parietal bones that make up the sides and tops of the head,
one occipital bone that makes up the back of the skull.
The sutures are the lines in between the bones. These stay open to allow for the baby to move through the birth canal, as well as to accommodate brain growth as the baby grows. You may have heard of a baby’s “soft spot".” These are the triangular meeting spaces between the sutures you can see above and are called “fontanelles”.
The posterior fontanelle is the smaller soft spot in the back of the head. This typically fuses by the time a baby is two months old.
The anterior fontanelle is the larger, more apparent soft spot right behind the baby’s forehead. About 90% are fused by the time a baby is 18 months old, but some do not fully fuse until 24 months of age.
How a Flat Spot Develops
Considering the pliability and flexibility of a skull that has plates of bone that can move and shift, it is simple to see how a flat spot can form. Regardless of the source of the contact or pressure, a skull that is in one position for a considerable amount of time will take to the mold it is set upon.
Plagiocephaly (picture in the middle): Forms when there is sustaining contact on one side of the head, which could be from:
the skull being in contact with a bone or part of the womb for a prolonged length of time,
a preference for turning the head in one direction whenever lying on their back,
neck tightness that keeps the head turned in one direction when in a swing, car seat, or bouncer,
habitual feeding or holding where only one side of the head is in contact with the caregiver’s body.
As you can see and imagine, contact and pressure on one side of the back of the head results in a shifting of the bones around that pressure, resulting in a flat spot.
Brachycephaly (picture on the right): Forms when there is sustaining contact on the back of the head more centrally, which could be from:
the skull being in contact with a bone or part of the womb for a prolonged length of time,
a preference for sleeping with the nose pointed to the ceiling with little neck movement,
long amounts of time spent in containers (car seats, bouncers, swings, etc) with little tummy time.
How We Can Use This Information
Preventing Flat Spots
For parents who hope to be intentional about preventing a flat spot, the general advice is to:
be mindful of positioning the baby with the head turned equally in both directions during bassinet or crib sleep,
limit container usage to less than two hours per day,
prioritize tummy time and unrestricted play (place Baby on a blanket on the floor to encourage full motion and movement)
Keeping Flat Spots From Getting Worse
Early intervention is key: we recommend seeing a head shape expert at the first sign of a flat spot,
Implement all of the strategies above with a greater focus on positioning the baby so there is more contact and pressure on the non-flat side,
consider seeing a pediatric chiropractor and/or physical therapist to assess for any neck tightness that could be contributing to the flat spot,
implement a head shape program like the one we have created to correct the flat spot without a helmet.
This baby was part of our Head Shape Program, where we taught the parents how to reposition her during sleep in order to keep her off of her flat spot (her back left).
Correcting a Flat Spot That Has Developed
The strategy for correcting a flat spot is dependent on a few factors:
the baby’s age,
the baby’s developmental milestone progression,
the severity of the flat spot
Age
For babies who are between the ages of zero and three months, the mode of correction would be using repositioning techniques and restricting container usage - our Head Shape Program is designed specifically for this!
Related: Is It Possible to Correct a Flat Spot Without a Helmet?
For babies who are between the ages of 4-18 months, the mode of correction is a cranial remolding orthosis (aka, a helmet). Helmets are approved by the FDA for wear between the ages of 4-18 months, so once a baby is over 18 months, there is no longer treatment for a flat spot.
A helmet works by “holding” the parts of the head that are elongated (called “bossed areas”) with gentle contact inside the helmet.
As the baby’s head gets bigger, the growth is directed into the the flat areas (“void spaces”), creating a more round shape.
For more details on how a CRO works, visit here.
Developmental Milestone Progression
Babies who are not rolling (even if they are over four months old) are eligible for repositioning and the Head Shape Program. Once a baby begins to show signs of rolling, they are no longer able to safely participate in the repositioning techniques and then will be referred for a helmet if deemed necessary.
Severity of the Flat Spot
Flat spots are categorized on a severity scale, from optimal head shape to very severe. The severity level at which a baby begins treatment influences the length of time treatment will be needed, regardless of the mode.
Most insurance companies consider helmets to be an appropriate treatment for babies with a severity level of moderate, severe, or very severe. This doesn’t mean that families cannot choose to use a helmet for a mild case — insurance just may choose to deny the claim.
There are many opportunities to correct head shape whether your baby is 1 month old or 1 year old. Many pediatricians offer the wait-and-see approach, but we truly believe that early intervention is the gold star of treatment. We hear over and over again from parents how much they learn from our consultations and how much peace that appointment offers regardless of treatment recommendations.
If you want to schedule a free consultation or explore all of the services we provide, visit our services page. We are here to help!