Preventing a flat head and head tilt

Plagiocephaly, or Flat Head Syndrome, is a flattening or misshaping of an infant's skull. It is often caused by maintaining a particular position for a prolonged amount of time.  Infants have fontanelles, or soft spots, making the skull malleable, and whether it’s too much time spent in a carseat or lying on the back, prolonged pressure to a particular area of infants’ heads causes that area to flatten.

Torticollis is characterized by a persistent head tilt or turn and is most commonly muscular in nature and originating at or short after birth.  The muscles on the side of the head tilt get tight and the muscles on the opposite side get over stretched, or weakened. Because of these muscular imbalances, torticollis can affect the way your baby visually perceives the world and can affect gross motor development.

Physical Therapist Sonia Khiantani, PT, DPT, explains these two conditions and demonstrates ways to prevent them.

Tummy Time with You
Tummy time is one of the most important positions in which your infant can play.  Not only does it promote overall mobility, but this play also encourages an infant to develop head control and neck strength (which help prevent torticollis), and keeps pressure off the skull (which helps prevent plagiocephaly).  Tummy time should be performed as often as possible during an infant's playtime and can be started as soon as a baby is born.  One way of starting tummy time with a newborn is to lie the infant on your chest.  The straighter you lie down, the more challenging the task is for your little one.  Even holding your baby supported at your shoulder with the head free allows the infant to begin to assume control of the head.

Tummy Time with a Towel Roll or Boppy Pillow
To allow an infant to be successful at first lifting the head, you can also roll a towel or receiving blanket long-ways and place it just under the nipple line with the arms in front.  This provides a bit of elevation, so that the force of gravity is less on the infant’s head.  A Boppy pillow can also be used to accomplish the same goal and is sometimes preferred by infants who have reflux issues, as the opening in the Boppy allows for less compression on the stomach.

Sidelying
Sidelying is another great way to remove prolonged pressure from the back of the head.  It promotes bringing the arms to the center and also promotes sustaining visual gaze with the head centered.  Be sure that you alternate sides with your infant to promote symmetry.

To prevent torticollis, this prolonged tilting or turning of the head, it is important to keep your infant’s head centered in the carseat, in infant positioners, and during feeding.  Again, varying your child’s play positions, providing opportunities in play to strengthen neck muscles, and keeping the head centered are key ways to prevent a flat head or a head tilt.

If you do suspect that your child has one of these conditions or if you have noticed any head flattening or persistent tilting, notify your child’s local pediatrician.  Treatment is usually conservative and generally involves a referral to physical therapy for stretching and strengthening exercises.  Research shows that the earlier an infant is diagnosed, the better the prognosis.