Newborns: Flat heads and tummy time

Everything you need to know about soft spots, pointy noggins and flattened-head syndrome.

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Photo: Lisa B./Corbis

Eric Tarasick, a father in London, Ont., was completely unprepared for the sight of his baby’s head emerging from the birth canal. “It was the longest, strangest- looking cone head I’d ever seen. For a second I thought we were having an alien,” he laughs. Thankfully, it didn’t last long – Tarasick and his wife had a perfectly healthy baby girl, named Iris. Even though a newborn’s head will relax back to a normal shape within days, if not hours, it can still be a shock, initally, for new parents.

All babies (even those delivered by C-section) are born with malleable skulls and two soft spots, called fontanelles, which allow the bones to overlap during the tight squeeze of childbirth. The posterior fontanelle, on the back of the head, is a small triangle shape that usually closes by the time your baby is eight weeks old. The anterior fontanelle, on the top of the head, is a larger, slightly sunken diamond shape. The bones in this area don’t completely close until a baby is about 18 months, to accommodate her rapid growth .

In the meantime, parents may gaze down in wonder at the anterior fontanelle, pulsing to her heartbeat. “I definitely felt very protective of the top of Iris’s head at first,” says Tarasick. “We didn’t want anything to bump her soft spot.”

Because infant heads remain fragile for many months, there’s a risk of a condition called positional plagiocephaly, or flattened-head syndrome.

“This is a result of the head staying in the same position for an extended period of time,” says Christopher Forrest, chief of the division of plastic surgery and medical director of the Craniofacial Care and Research Centre at the Hospital for Sick Children in Toronto. This can be caused by the constant pressure from car seats, and from lying on their backs to sleep and play. In some cases, flattened heads can develop in utero, if quarters are cramped, but this is rare (it’s most often seen with twins or triplets).

In fact, a new study in the journal Pediatrics has found that nearly half of two to three-month-old Canadian babies may have some form of this condition (although it’s usually a mild case).

To avoid flat-head syndrome, place toys or a mobile on her less-preferred side, and put her on her stomach a few times a day for supervised tummy time. She should still sleep on her back, however. “We don’t want to discourage back sleeping – it’s the best way to reduce the risk of SIDS,” says Forrest.

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Kori Plesiuk, who lives in St. Adolphe, Man., noticed her daughter, Sophie, was developing a flat spot around four months of age. “It was at the back, on the right side of her head,” Plesiuk says. “Her head was becoming almost teardrop-shaped.” After a referral to a specialist, they discovered Sophie had torticollis, a disorder involving shortened muscles on one side of the neck, which causes the baby to look in that direction. (It’s a common contributing factor for flattened-head syndrome.) “We went through physiotherapy first, and it helped her motor development, but didn’t help her head,” says Plesiuk. The next part of Sophie’s therapy was being fitted for a corrective helmet.

“In some cases, we recommend corrective helmets for children with moderate to severe skull asymmetry,” says Forrest. Sophie wore her custom moulded orthotic helmet 23 hours a day (baths and tummy time were exceptions) for three and a half months until her flat spot went away. Luckily, the helmet didn’t seem to bother her one bit. “She couldn’t have cared less about it,” says Plesiuk. It was more of a shock when the helmet came off, because she’d gotten used to being able to bump her head without feeling anything.

If you think your baby is developing a flat spot, talk to your doctor, but don’t panic: It won’t inhibit brain development and doesn’t cause developmental delays. In most cases, an infant’s head will round out in due time.

A version of this article appeared in our July 2013 issue with the headline, “Heads up,” p. 50

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