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Flat spots on babies' heads: what parents need to know and do

Posted by Dr. Claire McCarthy  July 8, 2013 07:43 AM

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The good news first: since 1994, when the American Academy of Pediatrics (AAP) started recommending that all babies sleep on their backs, the rate of Sudden Infant Death Syndrome (SIDS) has dropped by 50 percent. That's a lot of lives saved.

baby head.jpg
The bad news, which in comparison to that doesn't seem like a big deal: more babies are getting flat spots on their heads from lying on their backs. In fact, in a study just released, researchers in Canada found that almost half of the 2-month-olds they examined had some of this flattening, called positional plagiocephaly.

The skulls of babies are actually not one bone but lots of them held together by cartilage. This allows the head to squeeze through the birth canal, and it allows for the rapid brain growth we seen in infancy. The fact that there are many bones and that those bones are so able to adapt to change means that they are likely to be affected by position--and end up with flat spots when babies lie in the same position a lot. Usually, the flat spots are noticeable by the time a baby is a couple of months old. 

Luckily, these flat spots don't cause any damage to the brain--and most go away once babies are older and not laying down so much. They can sometimes be permanent, and leave a child with an odd-shaped head, which could lead some some teasing or self-esteem problems. For that reason, if the flattening is severe, we sometimes fit babies for soft helmets that help the head grow into a rounder shape.

The best way to prevent the flat spots from happening in the first place is to change the position of your baby's head regularly, so that he isn't spending 24 hours a day with pressure on the same part of the skull. Here are three suggestions for doing this:

1. "Tummy time." Having your baby spend time on his tummy is also good for building strength in the neck, trunk and arm muscles. So when he's awake and you're watching, put him on his belly. Many parents tell me their babies don't like this, that they fuss and so the parents end up giving up after a couple of minutes and putting the baby back on his back. You can help this by putting fun things to look at in front of the baby (like a baby mirror--babies love those), but the best thing to put in front of Baby is ...you. Get down on the floor too, on your belly, face-to-face with your baby. Or put Baby on your chest; you can talk to him, but just being so close to you may be enough to make tummy time more than worthwhile.

2. "Wear" your baby, in a sling or other baby carrier. This can take pressure of the head too. I wore my babies in a sling; I loved having my hands free, and they loved being carried all the time! Wearing your baby may also decrease the risk of colic (or help decrease fussiness in an already colicky baby).

3. Vary the direction your baby's head is facing when he is on his back. Because of the way they usually hang out in the birth canal as they drop down at the end of pregnancy, babies have a tendency to turn toward the right (in the study, more babies had flat spots on that side). When you lay Baby down to sleep, try to alternate sides. If you have a baby that likes to turn to the right, during the day position him so that the more interesting stuff to look at (like you) is on the left.

If you think your baby has a flat spot on his head, mention it to your pediatrician at your next checkup. Together you can decide if a referral to a specialist is a good idea; usually, it's not necessary.

Whatever you do, don't put your baby on his belly to sleep because you are worried about a flat spot. We can so something about a flat spot. We can't do anything if a baby dies of SIDS.

Boston Children's website has a great video that explains positional plagiocephaly--check it out.



Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.
This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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