Uneven Head Shape in Babies : "Flat Head Syndrome", Plagiocephaly, Scaphocephaly or Brachiocephaly : County Osteopaths : Cranial Osteopathic Clinic : Joanna Young, Lynette Topham & Jonathan Mussen : Osteopath Worcester, Malvern, Birmingham, Droitwich, Pershore, Bromsgrove, Evesham, Tewkesbury, Kidderminster, Redditch, Halesowen, Stourbridge

All views expressed here and advice given is the personal opinion of the author based on years of experience treating babies, children and adults with Cranial Osteopathy and raising children of her own.

Uneven head shape is also known as "Flat Head Syndrome", Plagiocephaly, Scaphocephaly or Brachiocephaly

It is believed that more babies develop an uneven shape to their head nowadays because we put them to sleep on their backs. However, some babies are affected and others are not so why does sleeping on their backs affect some babies and not others?

An uneven head shape is caused by the baby's head moulding into a certain shape, due to the position the baby was lying in, inside the womb. Moulding in the womb is more likely in mulitiple pregnancies. In premature babies moulding occurs due to the weight of their still soft head having to lie on a mattress when it is still suited only to the watery cushioning of the womb. . This may show as an uneven head shape at birth but more often only comes to light as the baby's head grows. It is usually evident by the second month of life. Why does moulding in the womb cause long term head shape uneveness? It can result in stiffness and distortion in the bones that form the base of the skull and it can cause torticollis - tightness in the neck muscles on one side so that the baby always lies with its head turned to one side and cannot turn it fully to the other side. Osteopath can detect and treat these causes using a special technique known as Cranial Osteopathy.

What are the names of the different head shapes?

brachycephaly - flat right across the back of the head (brachy = short, cephal = head)

plagiocephaly - a parallelogram-shaped head when viewed from above (plagio = oblique)

scaphocephaly - a head which is long and narrow from front to back (scapho = boat), this is the commonest in premature babies

Before worrying about your infant’s head remember different head shapes do run in families and some family head shapes are naturally flatter across the back or narrower from side to side or taller from top to bottom than others (an inherited head shape should be symmetrical though so a lumpy head or one that is asymmetrically flattened is probably not an inherited trait). So is your child’s head really a concern? If you are worried speak to all the people you trust, for instance your GP or Health Visitor and, of course, your friends for their honest opinion.

If you think there is a problem, be reassured that unusual head shapes are not a threat to your child’s health, development or intelligence and there are things you yourself can do to help.

1) Repositioning Therapy: In the first six months you are advised to try this at home and all it involves is a series of measures you can take to minimize pressure on the flat areas of your child’s head. These measures vary according to where the flat areas are but include the following: -

• try a neck support for when your baby is in its car seat to keep the weight off the flat area of its head (see below for where to buy one)

• plagiocephaly i.e. if your baby has a parallelogram shaped head get it to sleep with its head on the opposite side to the flat side (after first of all treating any torticollis that exists or they may not be able to turn the other way). Try a) putting them down with their feet to the other end of the cot to encourage them to look the other way to see the light / a mobile / you, b) lying them on their side to sleep, you may need to support them with a rolled up towell behind their back (check with your health advisors about their opinion of the safely of lying on the side for a baby first) or c) using a wedge shaped support under their body to tip them slightly to the other side (see below for where to buy them).

• scaphocephaly i.e. if your baby has a very long head from front to back you can get a support base with a hole in it to support the head upright avoiding pressure on the sides of the head ( try boppy.com* for its "noggin nest" )

• brachiocephaly: if your baby’s head is flat across the back, get them to sleep on alternate sides supported with a rolled up towel (check with your health advisors about their opinion of the safely of lying on the side for a baby first) .

• reduce the amount of time your baby spends lying on its back or reclined in any sort of seat. Try putting it to play on its front, so-called "tummy-time"(supported under the armpits and chest by a folded towel if necessary). From about four months try putting it in a Bumbo seat, door-bouncer or baby entertainer for short periods of time i.e 15 minutes or so to begin with.

• if bottle feeding, swap sides each time to encourage equal movement of their neck to each side.

• if they suck one hand, cover it with a mitt to persuade them to suck the other side.

• try carrying the baby forward facing in a baby pouch.

2) Specialist advice:

• for Torticollis (inability to turn the head to look round to one side as far as to the other due to tightened muscles in the neck) ask your GP to refer you to a physiotherapist to be shown how to stretch the tight side.

• take your child to an Osteopath experienced in treating children to treat the underlying causes of their uneven or flattened head shape.

• look up further information on other websites e.g. parents' forums, NHS Direct*

• there are private clinics that offer a head brace or helmet that mould the head into a better shape, if you are undertaking this sort of measure I would recommend Cranial Osteopathy before fitting and during the full treatment period in order to minimise stress on the skull.

Once a baby starts to sit up unsupported (at around 6 months) you should notice a big improvement in the head shape in the coming few weeks and months as they are spending less time with weight against their head. Continue to encourage them to play on their front. Further improvements should continue naturally right up until they go to school. after which further changes are small.

All treatments, whether it be repositioning, cranial osteopathy or even a helmet, involve harnessing the most rapid period of head growth between birth and 18 months. During this time all efforts are made to remove obstacles to correct head growth and to encourage the skull bones that are flattened where growth had previously been stifled to “catch up”.

The following link is a good place to look for information on repositioning aids and where to buy them: http://groups.msn.com/PlagioUK/repoproducts.msnw. *

*These websites are provided as a courtesy, we cannot accept responsibility for the quality of information on them or any items purchased from them.