Which Babies Are More Likely to Need a Cranial Remolding Helmet and Why?
Why might one baby develop a flat spot but not another? Although not definitive, there are some known risk factors associated with cranial deformities.
A common question we get from parents during our cranial consultations is, “why did this happen?” - meaning, why did my baby end up with a flat spot? In some cases, we can be pretty certain of how the flatness developed, but in others, it’s not as clear. During our intake process, we ask questions about the pregnancy and birth, as well as medical and developmental elements in order to gain a well-rounded understanding of what may have lead to flatness.
Listed below are a few reasons why a baby may have developed a flat spot. The greater amount of these risk factors present, the greater chance of a flat spot.
Babies with torticollis.
Torticollis is the greatest predictor of the development of a flat spot. We’d feel comfortable saying that by-and-large, babies with one-sided flatness (plagiocephaly) have some degree of torticollis.
Torticollis is one-sided neck tightness (but it impacts the whole body). It begins in the womb 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.
(image from: https://icloudhospital.com/specialties/torticollis)
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.
Premature birth.
Preemie’s spend extra time outside of the womb, meaning they are on their back more than if they stayed cookin’ until full-term. This could lead to a baby lying on their back for sleep for an extra 4, 6, even 8 weeks before meeting milestones versus one who was born near their due date. Preemie’s are also at a greater chance of requiring a NICU stay, leading to the second point…
NICU babies.
Babies who require NICU (Neonatal Intensive Care Unit) time are often medically compromised and spend much of their time on their backs for the early days or weeks of their lives - especially if they have tubes or leads that require them to stay lying on their backs. Despite the care team doing their best to change the way the head is turned, this sustained pressure on one or both sides of the head can lead to flatness. This is the most often cause of the scaphocephalic head shape.
NICU image below courtesy of: link.
Twin image above courtesy of: link.
Multiples.
Womb-mates are at a greater risk for developing flat spots for a number of reasons. Firstly, lack of intrauterine space can lead to a cramped space, putting pressure on the head from Mom’s ribs or pelvis. Secondly, multiples are more likely to be premature (see above) as well as at a greater risk for needing NICU time (also see above). Lastly, more babies to care for often equates to more time spent in containers, such as a swing, bouncer, or car seat; it isn’t as simple for a parent to carry or babywear two or more!
Boys.
It is understood that boys are at a greater risk for a flat spot than girls. This is thought to be for a few reasons: 1) boys are often bigger at birth with larger head circumferences, which can lead to more compression in the womb and/or during the delivery process; 2) boys heads also grow more quickly than girls, which creates more opportunity for gravity to do its job as the head grows.
Related: Flat Head Syndrome: How a Flat Spot Can Get Better or Worse
Developmental delays.
We typically see cranial deformities peak around 5.5 months of (adjusted) age. This is for a few reasons: head growth begins to slow + babies begin to roll much more consistently and enjoy sitting up supported. If a baby is not rolling - or at least attempting and getting onto their sides - they continue to spend a considerable amount of time on the back of their head. More time on the back of the head = greater risk of flatness. Monitoring a baby’s developmental milestone progression is part of our evaluation, as it gives us a clearer idea of not only what led to the flat spot but also gives us a prediction for how long a baby may need the helmet.
Note: once a baby begins to roll, it means their flat spot likely won’t get too much worse. But this doesn’t mean it will correct itself. Read this to learn more about how it improves.
Super solid sleepers.
Oh, those great sleepers. These are the kiddos who are sleeping through the night by eight weeks of age and continue to do so through four or five months. While it’s the stuff of dreams for parents, it can create a environment ripe for flatness. Twelve hours at night PLUS two to four naps during the day is a lotta hours on the back of the head.
We’d never suggest waking the baby for the sake of head shape; optimizing time when Baby is awake with strategic tummy time and positional modifications can help with what is within a parent’s control.
Building awareness around risk factors for cranial deformities can certainly help prevent them in the first place, but also helps parents release guilt around a flat spot that is already present. We stress that the great majority of flat spots could not have been prevented and - although it seems daunting - ensure parents that helmet treatment is a safe and super effective way to correct a flat spot.
If you are concerned about your baby’s head shape, schedule a free, no-pressure consultation or a quick discovery call. We are happy to help ease your concerns and fears around head shape - just like we’ve done for dozens of families.