Will It Even Out or Will It Not? A Question about Head Deformation

20 October 2021 0-3 months 4-7 months 8-18 months Asymmetry The Head

I’ve previously discussed the details of different types of flat head syndrome.

We know that in the case of plagiocephaly (flattening of one side of the head), the problem often fixes itself once babies gain better control over their bodies outside of Mom’s belly. 😉

However, until we are 100% sure that there are no “technical” obstacles that could hinder the child’s healthy and balanced development… we can’t be fully at ease.

That’s why – even though I’m not a big fan of dragging children to physical therapy unless they need it… if I noticed any head flattening in my child (and I wasn’t a physical therapist myself ;)), I would consult a specialist.

That doesn’t have to mean that from now on, your child will be doomed to visiting the doctor on a regular basis, but believe me – peace of mind is everything. 🙂

Why we shouldn’t underestimate flattening of the head:

Firstly – because a baby’s head grows very quickly and its shape changes very quickly. (In the first three months of life the circumference of the head increases by 0.8 in/month; between 4-6 months by 0.4 in/month, and after the 6th month of life by 0.2 in/month).
Secondly – because, in the case of strong, extremely persistent side preference, the baby’s face may become asymmetrical. If left untreated, asymmetry can spread to the whole body, which could greatly affect the quality of your child’s development.

Since research shows that the vast majority of children turn their head to the left, let’s analyze what could happen in the long-run if the child looks only to the left.

THE CHILD LOOKS TO THE LEFT:

The head is turned to the left, but tilted towards the right shoulder – as a result, in the long run, a flattening may appear on the left side of the head.
The right and left halves of the face may also develop asymmetrically. The eye and cheek on the side to which the child is looking may become larger; the cheek also more protruding; and the position of the ears may change as well (one ear might be higher than the other one).
The torso becomes arched in the direction in which the child is looking (left in this case).
The shoulder from the “skull” side lifts up. This could prohibit proper growth of the shoulder such that when the child lies down, he or she would be unable to rest both shoulders down evenly.
The weight of the body rests on the side that the child is facing, consequently, the butt cheek on that side may become larger.
The hips are positioned asymmetrically, which affects the position of the legs. The hip joint on the “skull” side is more exposed to dysplasia (abnormal growth on a micro or macroscopic level) due to the internal rotation occurring in the hip.

All of these dynamics of assymetry can have a significant impact on the bigger picture of child development because of the network of muscles that make up the body and compensation mechanisms that tend to take place. This can affect the way a little person looks, eats, and talks – now and in the future.

So we know that doing nothing is not an option here.

But… what can we do? What should we watch out for? What are the recommendations?

FLAT HEAD SYNDROME PREVENTION

1. First of all, we should make sure that the child turns his or her head in both directions – especially in the direction in which he or she doesn’t like to look.

2. Make sure that the child spends as little time as possible in a car seat or other equipment that encourages lying on the back while the torso is positioned at an angle to the ground (it makes it more difficult for the child to change positions, so he or she “escapes” into the one that is most familiar).

3. Lay your baby on the tummy and watch them in this position. If the child clearly lets us know their discomfort then we shouldn’t try to go over the limit of his or her tolerance. Instead, we can gradually get them used to this position – like by trying out these 3 Simple Steps.

4. Pay attention to details – check if in the child’s immediate environment there are objects that might encourage him or her to look in the favored direction too often or whether we don’t provoke that preference ourselves. Because… if, for example, the baby’s crib is up against the wall, and we always come up from the same side, there is a fair chance that the baby will be constantly turning his or her head in this same direction. And remember! not only toys can be “engaging”… curtains or paintings on the wall might be just as attractive…

What can you do about your baby’s environment? Firstly – don’t panic! 🙂 You don’t have to buy a new house… Rearranging all of your furniture won’t be necessary either. 😉 Most often, it is enough that you remember to change the baby’s position in the crib and to alternate which side you move your baby’s head to when you put him or her down. Give your baby one nap with the head looking right, and one nap with the head looking left.

5. Remember baby-friendly-care – while changing diapers, lifting or putting the baby down, we can implement rotations and encourage the child to be active (scientific research confirms that flat head syndrome is much less common in children whose parents have been instructed on how to properly encourage their babies to be physically active).

6. Do simple “exercises” with your baby during daily diaper changes that will encourage him or her to move more freely.

SOME SIMPLE EXERCISES:

1. Turning the head to the side so that the chin touches the shoulder once to one side, once to the other side (maintaining this position for about 10 seconds).

2. Tilting the head once in one direction, once in the other direction (holding for approx. 10 seconds as well).

We should do these exercises SLOWLY, and if we feel that there is a some kind of resistance, then we shouldn’t cross that line by force – instead, it’s good to consult a physiotherapist!

3. While playing with the baby, you can also lay him or her on your lap so that the head and body are in straight line. The baby’s bum should be higher than the head. In this position, the chin touches the sternum and the posterior neck muscles stretch.

Pillow with a hole? There are special pillows on the market that are sewn in such a way that the pressure on the child’s head is evenly distributed.
Do I recommend them? Yes, they can be helpful, but if your child has a “technical” problem, a pillow alone may not be enough.
From my experience, I will add that it works best for the youngest children, because they are not yet mobile enough to fall from such a pillow while sleeping.

RULES TO USE IN CASE OF ASYMMETRY OF THE HEAD

I am often asked what steps to take to prevent and detect flat head syndrome. When are simple adjusting exercises enough? When does the baby need, for example, helmet therapy? Or when to wait until… the abnormalities go away on their own?

Any time we notice head flattening or distortion, we should check with a specialist who can assess the development of the child and make a treatment plan.

Source: www.jpedhc.org

Interesting facts:

Head flattening is more visible in the first weeks of life, but as the child develops, it begins to recede. Its peak, when the situation looks the worst, usually falls on the 4th month of life. After that, we should notice significant improvement.
The children most at risk for flat head syndrome are those who have limited mobility of the cervical spine, decreased muscle tension in the center of the body, and have difficulty with tummy time. Other risk factors for flat head syndrome are: assisted delivery, giving birth for the first time, the position of the baby in the mother’s womb, or lying on the back for long periods of time. Flat head syndrome is more prevalent in boys.
There is a connection between deformation of the skull and wryneck (a twisting of the neck which causes the head to tilt at an odd angle). In the case of wryneck, immediate medical intervention is necessary.
Infants suffering from flat head syndrome are usually less active. Although no connection between head flattening (if it isn’t caused by the fusion of cranial sutures) and brain development has been indicated, they may show signs of delay in certain areas of development (sitting, rotating, crawling…).
In case of an unusual shape of the head, the possibility of craniosynostosis, i.e. premature fusion of one or more cranial sutures, should always be examined.
Scientific research confirms that instructing parents on how to encourage their children to be active, significantly reduces the risk of flat head syndrome.
Flat head syndrome is best treated before the baby is one year old. Children who are treated before the 4th month of life have the best results.
In case of an extremely persistent side preference or when the child’s head clearly tilts in one direction only without improvement after physiotherapy – it is worth checking the child’s eyesight for disorders.