By Nicki Tottenham
Some babies can develop a flatter head shape on one side in the first few months after birth. As the babies’ brain grows, which happens very fast, it will push out into the soft bones of the baby’s head. The other way the bone grows is the force acting from the outside by the baby’s ever strengthening neck and torso muscles pulling onto the covering of the bones (the periosteum). The muscles are not used as much in utero, but once born they are used all of the time, not least of which for feeding.
In some cases this can lead to the development of a baby’s skull becoming uneven with one side or the back looking ‘flat’ in comparison to the rest of the head. This flattening shape on one side is called a plagiocephaly. If the flattening is at the back in the middle, it is known as brachycephaly. Both can be treated with manual therapy and at-home exercises and positional advice.
Estimates from research show that between 20-30% of infants experience some form of flattened head shape. There has been no evidence that it affects development and it is not considered a high risk condition, however there are measures that can be taken to help reduce the head shape preference and prevent it from getting worse or causing a long term deformity.
A plagiocephaly will usually appear in the first two to three months of a babies’ life. Occasionally it can appear as a result of the baby’s position in utero. Should you notice a severe flattening in your newborn baby it is best to speak to your GP about this as soon as possible as it may have a different cause and would need to be looked into by a paediatrician.
How is it diagnosed?
In order to have a clinical diagnosis the baby will need to be assessed and a paediatric osteopath is qualified to do this. It also needs to be evaluated to see what might be causing it and your osteopath can help with this too.
In most cases, an infants’ neck and torso strength can develop at different paces on each side. In time, this can lead to a head turning preference where it is more comfortable for the baby to lie. Your baby may only like feeding on one side and struggles to get comfortable on the other side. They may always go to sleep with their head turned one way, or even find it tricky turning to look fully in one direction.
There are also other causes such as the position of a baby’s cot or if the baby is always held the same way. If the baby is continually looking one way, this may quickly become a preference as those muscles strengthen.
How is it treated?
An osteopath will examine a baby to see if there is a difference in development of the cranial bones. They’re also looking for imbalances in the muscles of the neck and the torso to see if they might be contributing to a head turning preference. Babies aren’t able to address any muscle imbalances that might be there in the same way that adults can. They will need some help to even things out. Any imbalances found can be treated by manual therapy, often involving mild stretching techniques.
Cranial Osteopathy to help even out the development of the membranes surrounding the bones of the head can also be beneficial and is non-invasive and very gentle. Both of these treatments are safe and should not cause your baby any discomfort, though babies often like to wiggle and squirm when they are treated!
Helmet therapy is usually only for very severe cases, and would need to be prescribed by a GP or paediatrician. Your osteopath will let you know if they think your baby needs to see a GP for further investigation.
What can be done at home?
The other main form of treatment for a flat head is positional therapy which can be done very easily at home, and can also be part of a fun bonding process between family members and babies.
The Home environment:
This will involve looking at the baby’s environment at home: are they always having to turn their head to see out of a window, to look at mummy and daddy, to turn to the toys/television? All these things will attract a baby’s attention and they will turn to the stimulus. If the stimulus is constantly on the same side then it is recommended to change this – for instance to position them differently in their cot so they have to face the other way to see, or turn their baby bouncer or playmat around so they are looking in a different direction.
Gentle Repositioning:
Other techniques in smaller babies that are yet to develop good head control is to gently move the babies head to the non-preferential side when they are asleep or resting. This allows for the shorter muscles to stretch out and make it more comfortable for the baby to turn their heads both ways.
Also if you always hold your baby on one arm, try holding them with the other arm so they are in a different position.
Ultimately, the worst position to cause an exaggeration in the flattening, is for the baby to be lying on their back. They will inevitably turn to the prefered side and the pressure from lying onto it increases the flat spot. Saying this, babies tend to sleep quite a lot and it is recommended for them to always sleep on their backs. So, it is therefore vital that in those waking hours, they are brought up to play and be held. If they are lying on their backs on a play mat quite a lot in between sleeps, even with you playing with them, this could lead to more pressure. When you are down at their level with them on their back, keep them moving to turn to the non prefered side.
Tummy time and being held in a more upright posture (if they are old enough to sit up with less/no support is also good) is therefore highly encouraged.
Structured Playtime:
For babies who are starting to get some head control it is fun to play with them, moving down to their level and using toys and noise to get them to turn their head both ways. Older brothers and sisters often like being asked to help out with this type of playtime!
Tummy time is also very useful to help a baby to even out muscle imbalances. It forces the muscles at the back and sides of the neck to strengthen and stretch out. This in turn gently pulls onto the exterior of the skull where those muscles attach onto the bones. It is this pull that encourages the bone to grow out in the direction of force from these muscles.
All of these things will help, though should you be worried about this condition please contact us.
Some further information sources:
https://www.nhs.uk/conditions/plagiocephaly-brachycephaly/
https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Positional-Plagiocephaly
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