Sleeping Like a Baby — Without a Flat Head

Flat head syndrome in babies appears to be high but can be easily prevented

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Placing babies on their backs to sleep reduces the risk of sudden infant death syndrome. But sleeping on their backs may make it easier for babies to develop a flat spot on their heads.

A recent study found that nearly half of all babies in one city had some form of flat head syndrome. It's possible this finding represents similarly high rates of flat spots on babies' heads in other geographic locations.

Most cases in this research study were mild, and the condition is easily treated if parents are aware of it.

"Ask your pediatrician about proper sleeping positions."

The study, led by Aliyah Mawji, RN, PhD, of the School of Nursing at Mount Royal University in Calgary, Canada, looked at how common it was for babies to have a flat spot on their heads.

The medical name for a flat spot is "positional plagiocephaly," also called flat head syndrome. It occurs when a flat spot develops on the head, usually from a sleeping position, and causes the head to be asymmetrical.

The condition is not usually serious, but untreated cases can lead to permanent changes in the shape of the head or facial features.

Typically, treating this condition involves slightly altering a baby's position while the baby is asleep. Sometimes physical therapy or wearing a special baby helmet is recommended.

Babies should also continue to get plenty of tummy time, or time spent on their stomachs, during waking hours, as this helps promote neck muscle development.

In this study, researchers investigated 440 healthy babies who had all been born at full term (at least 37 weeks of pregnancy) when they attended their 2-month well-child visits.

The babies were from 7 to 12 weeks old and went to their well-child visit at one of four clinics in Calgary, Canada.

Nearly half these babies — 205 of them, or 47 percent — had some form of flat head syndrome.

Most of the cases (78 percent) were mild, and 63 percent of babies had the flat spot on the right side of their heads.

The researchers suggested that the high number of babies with a flat spot on their heads may be a result of the change in sleeping guidelines in 1992.

That year, the American Academy of Pediatrics began recommending that babies be put to sleep on their backs to reduce babies' risk of dying from sudden infant death syndrome (SIDS).

Canadian pediatricians recommended the change in 1999, and SIDS deaths in both the United States and Canada decreased.

The authors do not suggest changing those recommendations; babies should still be placed to sleep on their backs to reduce SIDS risk.

However, parents should be given information on preventing flat head syndrome, such as ensuring babies' position is altered during sleep.

According to Thomas Seman, MD, a pediatrician at North Shore Pediatrics in Danvers, Mass. and a dailyRx expert, flat spots are a common problem and always have been.

"When children would sleep on their bellies there was a flattening of the side of the face, but not as badly since the child would frequently move his head back and forth," Dr. Seman said.

He said he has definitely seen an increase in flat spots since the change in AAP's sleeping guidelines, but the numbers were surprising to him.

"Although I do see molding or flattening of the head, it does not seem that common in my practice," he said. "Any child may have some minimal flattening on the side that he/she lies on most frequently, although most often the flattening is symmetrical."

He offered suggestions to parents to help address flat spots.

"One can help with changing the position of the head periodically by placing a slight wedge under the one side of the child," he said. "This slight change is enough to alter the pressure placed on the soft skull bones of the child, thus decreasing head flattening."

Even when children are not sleeping, parents can help.

"Furthermore, tummy time while the child is awake and having the child more upright can also be beneficial," Dr. Seman said.

He noted that the study focused on children between the ages of 7 and 12 months, but molding/flattening can continue for a few more months. It just happens more slowly since the child will be sitting up on his/her own and thereby reducing the time on the back.

The study was published July 8 in the journal Pediatrics. The research was funded by the University of Calgary. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
July 4, 2013
Last Updated:
July 30, 2013