Positional Plagiocephaly: Is my baby's head flat?
Most parents don't hear ANYTHING from their doctor about preventing or monitoring head flattening until it's a problem. And even then (usually at 4 or 6 month check-ups), there's VERY OFTEN a "let's wait and see" response.
But with rates of Plagiocephaly or head flattening currently estimated to be as high as 48%, it's time to turn our attention toward prevention and early detection of head shape issues to prevent the rising need for baby helmets and the secondary risks of Plagiocephaly.
Let's look at some simple, quick ways to check your baby's head shape and explore why this is so important.
"I didn't notice my baby's head had a flat spot."
My clinical training and experience as a pediatric Occupational Therapist makes it easy for me to spot a flat head from 4 aisles over at Trader Joe's (where I'm usually found on the chocolate aisle). But for parents and other caregivers - it can be TOUGH to notice flat spots forming when they're subtle.
Here are some things that can make it tricky to notice irregularities or changes in your baby's head shape:
it's tough to spot gradual changes
you typically only look at your baby from a few angles
your eyes are drawn to your little love's adorable eyes and drooling mouth, not the shape of his skull
it can be very difficult to "eyeball" head shape changes (i.e. does that look worse than a few weeks ago? or just different? or the same?)
Why Early Detection of Head Flattening Is Crucial
The earlier you notice head shape irregularities - flat spots or asymmetries - the easier it is to treat them through simple positioning, activities and neck stretches (when needed) and minimize the chances of your kiddo needing a helmet (sometimes called a Cranial Orthotic or Cranial Band).
Types of Head Flattening To Look For
A "flat spot" on baby's head could be only on one side of the back of the skull. "He has a flat spot on the right side," is what a parent might report.
But Plagiocephaly isn't always just on one side.
Brachycepahly is a type of Plagiocephaly in which there is generalized flattening across the whole back of the skull. Often you see some bulging or fullness of the forehead and/or widening of the skull, particularly noticeable just above the ears. I tend to see parents missing this type of flattening because it’s symmetrical across the back of the head.
*many babies have some degree of Brachycephaly plus asymmetric Plagiocephaly.
Scaphocephaly is a type of Plagiocephaly in which the head is narrow and elongated. This is particularly common in premature babies or NICU graduates who spent a lot of early days in the sidelying position in the NICU.
The 3-Step Weekly Head Shape Check
Much like we're advised to do "kick counts" late in pregnancy, I suggest that parents do weekly head checks in the first 4 months of their kiddo's life with these 3 easy steps:
1. Get a bird's eye view of your baby's head
Baby has flattening on the back right of the skull.
Get directly above your little one's head (not a position you find yourself in much, is it?!). TAKE A PHOTO. That way you can look carefully at it without baby wiggling and you'll be able to compare photos from week to week for changes (tip: set up an album on your phone photo app).
Divide the skull into 4 quadrants by imagining 2 lines: one from nose to back of head and one from ear to ear (or from one ear to where the other should be). Ask yourself:
Do the front two quadrants look symmetrical and equally full? What about the back two?
Does the left half of your infant's head match the right in size, fullness and shape?
Are the ears even?
Does the back of baby's head look significantly less full and round than the front?
2. Lay baby down and view from the chin up
Baby’s forehead slopes to the right. Their right eye, cheek and forehead are pushing forward. Lips don’t line up (may indicate jaw misalignment).
Also not an angle you typically spend much time looking at your baby from, right?! Take that photo and look at it closely as you ask yourself:
Does baby's forehead slope left or right?
Do baby's eyebrows look the same?
What about the cheekbones?
Facial asymmetry occurs because what happens in the back of the skull impacts the front of the skull. Flattening in the back leads to pushing forward of the front (bulging or bossing). For example, a baby with a flat spot on the back right would be at risk for the right side of the face - forehead, eyebrow, cheek bone- to be further forward than the left.
3. Scroll back through recent head shape photos
Look for any subtle changes in head shape from week to week and month to month. I also encourage families using repositioning strategies to correct head shape do this step as well. It can be just as hard to see improvement in head shape as it can be to see a progression of flattening.
My Baby’s Head Looks Flat - Now What?
You are the person who is with your child the most and you can be the one to first notice flattening if you know what to look for. So what should you do if you notice flattening? Read on, friends…
Oh, and spoiler alert: "what to do" does not include becoming guilt-stricken, blame-ridden or hopelessly resigned to your baby wearing a helmet.
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