Boston Othotics and Prosthetics
Boston Othotic and Prosthetics

Is Your Baby’s Head Flat on One Side? It Could be Due to this Congenital Condition

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Many babies develop a flat spot on one side of the head, called plagiocephaly. While some cases of head flattening are the result of a rare birth defect (congenital plagiocephaly), most cases of flat head syndrome are positional plagiocephaly, which means that the flat spot has developed due to the baby’s head frequently resting in the same position.

How to Tell if Your Baby has TorticollisIn many cases, a baby’s head will start to flatten on one side because the baby has a preferred side (right or left) and will predominantly rotate the head in that preferred direction. Eventually, because one side of the baby’s head spends more time in contact with a surface, like the floor or a crib mattress, that side of the head begins to flatten.

Almost always, favoring one direction of head rotation is not due to a simple preference on the baby’s part, but is rather an involuntary reaction to a tightening of the neck muscles. This muscle tightening, called congenital muscular torticollis (CMT) or just torticollis, makes it more comfortable for the baby to rest the head on the preferred side.

Parents who have noticed a flat area developing on their baby’s head may be advised by their pediatricians to try tummy time and repositioning to encourage the baby to rotate the head to the non-preferred side. While these methods can potentially improve the shape of the head and stretch the neck muscles, they may be less effective in babies with torticollis.

How to Tell If Your Baby Has Torticollis

According to Dr. Gary Rogers, the Chief of the Division of Pediatric Plastic Surgery at National Children’s Hospital and a foremost expert on plagiocephaly, any infant who shows a strong and persistent head rotation preference has CMT. “I have heard every possible theory used to explain this behavior (i.e., handedness, the orientation of the room, side of breast feeding, etc.) but these are incorrect and dismissed by a simple test,” said Rogers.

“Change the orientation of or remove any of these environmental stimuli and in infants with CMT, the preference remains. There is no reason, other than CMT, that an infant would consistently choose to keep their head to one side.”

There are varying degrees of torticollis. In very mild cases, neck motion is minimally affected and the preferred rotation may resolve on its own, so there may be no head flattening at all. Severe cases may require surgery, but most cases fall somewhere between those two extremes.

For babies with moderate to severe CMT, it is very uncomfortable to rotate the head to the side with the tight neck muscle, and they will avoid it at all costs. In can be very difficult for parents to continue trying to make the baby switch to the non-preferred side.

Treatment Options for Babies with Torticollis

Any child who has been diagnosed with CMT should be referred to a pediatric physical therapist who can help stretch and strengthen the neck muscles to resolve the imbalance.

Babies with CMT will benefit most if they receive physical therapy before they are 3 months old. Early intervention will help resolve the main cause of the head flattening and prevent it from becoming permanent.

In conjunction with physical therapy, another excellent option is switching from a flat sleeping surface to one that is contoured to the baby’s head to help promote natural head shape and symmetry as they sleep.

At Boston O&P, we recommend the Perfect Noggin, a contoured sleeping surface for infants who are not rolling over from their back to tummy independently that encourages symmetrical head growth. The Perfect Noggin was created by Dr. Rogers and Boston O&P orthotist James “Rusty” Miller, CPO.

The Perfect Noggin can be used as a sleep surface until the infant is able to roll over from their back to their stomach, at which point the use of the Perfect Noggin should be discontinued.

If you have noticed a flattening on your baby’s head and you are concerned about plagiocephaly or torticollis, contact a Boston O&P clinic to schedule a free consultation with a certified orthotist specializing in plagiocephaly. The consultation includes screening for torticollis, as well as treatment recommendations. Schedule a free evaluation now.

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