Flat head syndrome is caused by prolonged pressure on an infant’s skull during pregnancy or early infancy.
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Types of Flat Head Syndrome
There are 2 types of flat head shapes, although some infants can have both forms. In plagiocephaly, the back of the head is flat on one side. In severe cases, this may cause the ear on that side of the head to appear pushed forward and/or lead to an uneven appearance of the face, neck, or jaw. In brachycephaly, the back of the head is flat and the head appears wider than normal.
Flat head syndrome does not affect brain development or intelligence. Approximately 1 in every 8 healthy infants younger than 1 year have flat head syndrome, although most have a mild form. Diagnosis is made by a clinician based on physical examination.
Rates of flat head syndrome increased after the 1994 recommendation that infants sleep on their backs to prevent sudden infant death syndrome (SIDS). Flat head syndrome is also associated with prolonged use of infant carriers, multiple births, prematurity, and delayed attainment of motor skills such as rolling over or sitting without support. Infants with conditions that limit neck mobility, such as torticollis (in which neck muscle contraction causes the head to twist to one side), are at increased risk of developing flat head syndrome.
How to Prevent Flat Head Syndrome
Flat head syndrome can be prevented by having caregivers alternate the side of the infant’s head that is facing down when laying infants on their backs. It is also important to limit the time infants spend in car seats, swings, and infant carriers. Frequent supervised episodes of placing infants in the prone position when they are awake, known as “tummy time,” for a total of 30 minutes per day helps decrease the risk of flat head syndrome.
How Is Flat Head Syndrome Treated?
Mild flat head syndrome may be corrected by efforts to reposition the head when laying the infant down and/or physical therapy to improve neck mobility and to promote attainment of developmental milestones. Infants with moderate to severe flat head syndrome may benefit from helmet therapy.
What Is Helmet Therapy?
Helmet therapy involves using a medical device that redirects normal head growth to flat skull areas. The helmet is recommended to be worn 23 hours a day, including during sleep. Helmets are custom-made from lightweight, rigid materials such as plastic and have foam padding on the inside for comfort and to allow for growth of the infant’s skull. Helmet design varies based on the specific needs of an infant’s head shape; helmets are fitted by a trained professional such as an orthotist. Helmet therapy can be used for infants with flat head syndrome as early as 4 months but no later than 12 months of age. Duration of treatment varies depending on the severity of skull asymmetry and the age at which helmet therapy is started.
Helmets should be cleaned daily with 70% isopropyl alcohol. Wipes, powders, and lotions should not be applied to an infant’s head or to the helmet. Wash the infant’s head daily and apply the helmet only when the head and the helmet are completely dry.
For More Information
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Article Information
Published Online: April 11, 2024. doi:10.1001/jama.2023.26048
Conflict of Interest Disclosures: None reported.
Source: Santiago GS, Santiago CN, Chwa ES, Purnell CA. Positional plagiocephaly and craniosynostosis. Pediatr Ann. 2023;52(1):e10-e17. doi:10.3928/19382359-20221114-03