About Flat Head Syndrome
By Philip Owen, Paediatric Cranial Osteopath.
Flat head syndrome refers to a baby’s head when it becomes misshapen due to the effect of the weight of the head being flattened against a flat surface or mattress.
(The above show relatively severe examples of the major conditions - Plagiocephaly and Brachycephaly. A rare condition, called ‘cranial synostosis’ also exists in which the sutures or gaps between the bones fuse prematurely making the head distort out of shape).
By far the most common cause of misshapen head is from a baby spending too long lying on a flat mattress.
Babies heads are generally soft and malleable up the age of one year old. It is up to this age approximately that the baby’s head is susceptible to becoming mis-shapen. This is also the age range where it is possible to achieve slow self-correction from flat head syndrome, if the pressure is removed through the use of helmets and certain mattresses.
How common is ‘flat head syndrome’?
There are varying degrees of ‘flat head syndrome’ and reported incidence varies widely, depending on whether all degrees of the condition, including mild flattening, are classified.
On their information website, Great Ormond Street Children’s Hospital published that ‘up to half of all babies develop plagiocephaly but to varying degrees.’
I personally think that this may have been the case 10 years ago when not only parents but medics also were very poor at spotting the early stages and development of abnormal head shapes in babies.
In addition, nobody likes to be the bearer of bad news so, if a family member or friend spotted a head shape problem in their friend’s young baby, it would be extremely difficult to bring it to their attention for fear of upsetting the parents.
In more recent times there seems to be much more awareness about looking for early signs of misshapen heads. Prenatal groups for expectant parents give advice on how to avoid flattening by repositioning and use of shaped/ergonomic mattresses, such as SleepCurve, to reduce the pressure on a baby’s head.
The SleepCurve mattress is designed to prevent Flat Head Syndrome though the curved shape which allows for the bulge in the back of a baby's head. The pressure on the skull is significantly reduced.
What is the effect on the baby if she/he is diagnosed with ‘flat head syndrome’?
The first effect is the obvious cosmetic effect. This in turn can cause stress and anxiety for the parents and potentially lead to self image issues for the child as it grows older. Parents tell me that once their precious baby’s head is recognised as ‘out of shape’, their attention is drawn to it constantly. However, there are mixed opinions on the other effects of Flat Head Syndrome.
In January 2006 The Journal of Plastic Reconstruction Surgery published some research by Kordestani et al entitled ‘Neurodevelopmental delays in children with deformational plagiocephaly’. The outcome, in summary, was that before intervention, infants showed significant delays in both mental and psychomotor development. Also it was noted that not one child with positional plagiocephaly showed accelerated development. See reference below…
Why has plagiocephaly become so widespead?
There are several factors to consider when understanding the reason behind the growth in cases of flat head syndrome.
Firstly, back in the mid-1980s the incidence of ‘cot-death’, or ‘sudden infant death syndrome’ (S.I.D.S.) was around 3,000 deaths per year for the UK alone. The number of births at the time was approximately 600,000.
It was noted that in the Far East where baby care culture was different to ours and babies were placed on their back to sleep the ‘cot death’ rate was far lower than ours here in the UK.
The government decided to issue a safety directive for parents of newborn babies and recommended that all babies be placed on their back to sleep. At the time babies were being placed to sleep on their tummies or their sides. The result was a highly successful campaign as the rate of ‘cot death’ fell from approx. 3,000 to 300 for UK alone!
Secondly, when a baby’s head is examined from the side, a bulge protrudes from behind the baby’s ears. This part of the skull is call the ‘Occiput’ which houses the ‘posterior cranial fossa.’
When a baby is placed on his/her back on a flat mattress what happens to this bulge? In babies without strong head control the head has to rotate to the side (left or right) see photo below:
However if a baby has developed head control s/he will be able to hold the head in the midline for short periods. See photo below:
Thirdly, when a baby is placed on their back and the weight of the skull is resting on the rounded part of the skull where the bones are thin, there is a possibility that this soft skull will squash to the shape of the flat mattress or flat bouncy chair or flat car seat.
It is our western culture to place babies into receptacles in which to carry them around or transport them. However in Eastern culture and third world countries where access to push chairs and prams is more limited, parents carry their babies in the crook of the cradling arm.
As a cranial paediatric osteopath I treat babies in the orthodox Jewish community. Out of the hundreds, if not thousands, of babies I have examined in my surgery I can honestly report that I have never seen a case of ‘flat head syndrome’ in any of these babies. The reason appears to be as a result of the culture in the orthodox Jewish community to carry babies more.