Plagiocephaly – Flat Head Syndrome

Kristie McNealy, MD

Plagiocephaly, or flat head syndrome, is a condition commonly seen in preemies and NICU babies, where a portion of the back of the head becomes flattened.  It is usually due to an infant spending long periods of time with its head resting on a firm surface like a mattress, bouncy seat or swing. Plagiocephaly is more common in preemies, and can also begin before birth due to cramped conditions in the womb caused by multiple gestations, or from lying in a breach position. Typically, it is diagnosed after parents notice a flat spot on the back of the head.
With the advent of the Back to Sleep campaign in 1992, the rate of SIDS has decreased 40%, but the rate of plagiocephaly has sky rocketed. Now, plagiocephaly is not a valid reason to place your baby on their belly to sleep, but there are other things that you can do to decrease the likelihood of your baby developing this condition.
When placing your baby down to sleep, alternate the way its head is facing, either to the right or to the left. Do this at nap time too. You can also alternate the end of the crib you place the baby’s head at, or the position of the crib in the room to encourage the baby to turn look in different directions. Give your baby regular tummy time, and try to minimize the amount of time spent lying on their back in bouncy seats and swings.
In general, plagiocephaly is a harmless flattening of the back of the head, but in severe cases it can result in asymmetrical facial features. In some cases, plagiocephaly can be caused by an abnormality of the neck muscles called torticollis, which can cause the head to tilt and twist to one side. In other rare cases, it can be caused by abnormal fusion of certain bones in the skull. Preemies are more prone to plagiocephaly because their skulls are softer than a term newborn, and their condition often necessitates spending long periods of time lying on their back without being picked up and moved.
If you notice a flat spot on your baby’s head, that doesn’t seem to be going away, see their pediatrician. There are techniques that can be used to correct the shape of the head, but they are most effective when started before 9 months of age, when the head is growing the most rapidly. Your pediatrician will be able to assess the need for a corrective helmet or band, and can also diagnose other problems that might be causing the flattening. If your child is diagnosed with torticollis or other condition they may be referred to specialists for further evaluation or therapy. If they are fitted with a helmet or band, they will most likely wear it for 23 hours per day for several months, until the head is reshaped.
As the parent of a premature infant, plagiocephaly is a condition you should be aware of. If your baby tolerates it, make sure that the NICU changes the position you baby is lying in at every care time. When you are able, time spent holding and doing kangaroo care can also help. In addition, you may notice that your NICU uses special gel mattress pads or pillows to help soften the surface your baby is lying on. Regardless of these conditions, your baby should still be placed on their back to sleep when you bring them home, unless your doctor advises otherwise.


Information provided on this website is for informational purposes only. It is not meant to diagnose or treat any condition, or to supersede the advice of your physician. If you have a medical emergency call 911 or your doctor immediately. Consult your physiscian as soon as possible for any concerns over your child’s health or development.

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