Positional Plagiocephaly: Is my baby's head flat?

how to tell if your baby has a flat spot. CanDoKiddo.com

Have you ever passed a baby in the grocery store or at the park who was wearing a helmet? If you realized that it was for correcting a flat spot on baby's head, it probably made you wonder how you can avoid your baby needing a helmet?

Here's the thing - 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 ALMOST ALWAYS 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). I KNOW that we can reduce the incidence of head flattening without increasing the use of helmets. 

Simple changes to increase babies' movement and improve their positioning can reduce the need for helmets AND avoid the secondary complications of decreased early movement (sensory processing challenges, poor motor coordination, decreased upper body strength, and more). 

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 it's important to also be aware that Plagiocephaly isn't always asymmetrical.

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. This is a very common skull deformity seen in babies who sleep in a Rock 'n Play. I wish I had a quarter for every parent who said, "My baby slept in a Rock 'n Play and doesn't have a flat head," but whose child actually does have Brachycephaly. Here are some tips for transitioning your baby from sleeping in baby gear to sleeping flat.

Scaphocephaly is a type of Plagiocephaly in which the head is narrow and elongated. This is particularly common in premies 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 in these 3 easy steps:

A simple weekly check for flat spots on baby's head. CanDo Kiddo

1. Get a bird's eye view of your baby's head

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 from week to week for changes. 

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?

Taking a quick look at this little lady, you'll see that her right back quadrant is much less full than her back left. The right front quadrant has a different shape than the front left. Her right ear is shifted forward compared to her left. 

Simple ways to check baby's head for flat spots. CanDo Kiddo

2. Lay baby on his back and view from the top

With baby laying on his back,  you'll be able to see several important features that can highlight flattening. Again, take a photo to examine and save for future comparison. Ask yourself:

  • Is one part of the back of baby's head not making as much contact with the floor as the other (as in the photo below)?
  • Is baby's head tilted to one side or the other due to a flat spot? 
  • Is there any slanting of the forehead?

Looking at the little guy below, we see the back left side of his head making less contact with the floor. Without seeing his nose, I can't tell if his head is tilted, but he definitely exhibits slant of the forehead toward the right.

examining baby head shape flat head syndrome

3. Lay baby on his back and view from the chin up

Also not an angle you typically spend much time looking at your baby from, right?! Take that photo and look for:

  • Does baby's forehead slope left or right?
  • Do baby's eyebrows look the same? What about the cheekbones? 

    In the photo below, we see the forehead sloping to the right (to his left). His right eye, cheek, and forehead are pushed forward (your left when looking at the picture), likely due to flattening of the right side of the back of his head. Also notice that his lips don't line up and I would guess his jaw alignment is being affected by his head shape.
positional plagiocephaly

This simple 3-step check for head flattening isn't meant to be a substitute for physical examination by a medical professional. But you are the person who is with your child the most and, in most cases, you will be the first person to notice flattening if you know what to look for.

You'll definitely want to initiate a conversation with your child's pediatrician if you are concerned about head flattening. In the next post in this series, we take an in-depth look at what to do if you notice a flat spot or other signs of Plagiocephaly. ** Spoiler alert: "what to do" does not include becoming guilt-stricken, blame-ridden or hopelessly resigned to your baby wearing a helmet.

Who has time for one more worry as a new parent?

Not you! Pregnant? Have a newborn with a healthy head shape you'd like to keep that way? Or can't stop worrying about baby's flat spot? NOW is the time to learn simple changes you can make to your daily routine that can prevent and correct Flat Head Syndrome. 

Just listen to how first-time mom Laura felt after implementing the strategies from the book:

"Not only did it give me the tools I needed to round out my son's flat spot (and get rid of his head turning preference), it was a surprisingly engaging and enjoyable book to read and I learned so much from it. My son is now 5 months old and his head is round! What a relief!"

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