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What Can You Do About 'Flat-Head Syndrome'?

'Flat-head syndrome' or to give it its proper medical name ' Positional Plagiocephaly' is a condition characterised by a flattening on one side of the back of a baby's head.

It may also involve bulging of the forehead, fullness of the cheek and ear misalignment on the same side as the flattening. Under the broad term 'Flat-head syndrome' there are two other head shapes: Brachycephaly and Dolichocephaly. In the former the head is wide in relation to its length and appears flat at the back; the head may have a high a 'peaked' appearance, and sometimes both sides of the forehead can be bulged. In the latter the head is narrow in relation to the length of the baby's head.

What Causes the Condition?

Newborn babies often have some asymmetry of the head due to the inherent stresses and strains of the birth process. This normally settles in the first few weeks after birth. However, because a baby's skull is still malleable and can therefore be shaped by external forces any existing flattening may not necessarily disappear of its own accord. It seems that the increased prevalence of the condition in recent years is an unfortunate by-product of the successful 'Back to Sleep' campaign. As this campaign has reduced the incidence of Sudden Infant Death Syndrome there is no suggestion that parents should stop their babies sleeping on their backs.

What are the Treatment Options?

The first option is to try to reposition the baby's head as much as possible with the aim of encouraging your baby to rest its head on the non-flattened area. The second option is for the baby to wear a Cranial Remoulding Orthosis but this should not be considered until the baby is at least 3 to 4 months old.

Repositioning Suggestions

The objective is to reduce the amount of time a baby spends resting its head in the same position. Following these suggestions may well be enough to encourage natural correction of a baby's head shape. At night time consider alternating the end of the cot where your baby lays its head. Turn your baby's head so that it is not lying on the flattened side. During the day encourage your baby to spend as much time on its stomach (tummy time must be supervised)as possible. Most babies dislike this initially as they do not have the strength to hold their head up. However persevere and gradually build up the length of time they spend on their tummy. This will also help them to build strength in their neck and trunk muscles. Make tummy time fun by spending time lying down with your baby on top of or in front of you. Use toys to entertain them.


Modern baby travel systems are a boon because they are conveniently designed to click together so that there is no need to wake your baby when transporting them from the car to the house. Unfortunately this can also mean that they can spend long periods of time lying on their back with their head against a hard surface. If at all possible try to minimise the time your baby spends in the travel system when not actually in the car.

Cranial Remoulding Orthosis

If repositioning techniques do not work, the next step is to consider Cranial Remoulding Therapy. The Cranial Remoulding Orthosis or Band looks very much like a bike helmet. It is non-invasive and works by applying constant pressure over the areas of the baby's skull which are most prominent while allowing unrestricted growth over the flattened areas. It is a pain-free treatment. The Band consists of a soft foam layer inside a thermoplastic shell. This allows for frequent adjustments during growth as the Band gently moulds the baby's skull into a more symmetrical shape.
Treatment is most effective in babies between 4-7 months old and takes between 3-6 months to complete. Babies up to the age of 14 months can be treated but the treatment is likely to take longer.

Mrs Joanne Drake BSc(Hons) SROrth MBAPO
Head Of Plagiocephaly Unit
The London Orthotic Consultancy

May 2007

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