Understanding a Flat Head in Infants and Adults
For many people, noticing a flattening on the back or top of their head can lead to concern. However, for most, a flat spot is a lingering, harmless result of development during infancy, known as positional plagiocephaly. The human skull, particularly in babies, is incredibly pliable, and continuous pressure on one area can lead to a reshaping of the soft bones. While this is the most common cause, other more serious, but far rarer, conditions exist that can affect the head's shape.
This comprehensive guide explores the different causes of a flattened head, differentiates between types of plagiocephaly, and explains when a flat head is normal versus when it warrants medical attention.
Positional Plagiocephaly: The Most Common Cause
Positional plagiocephaly is a common condition affecting infants, where a flat spot develops on the skull. This is not a cause for alarm, and its prevalence has increased since the recommended "Back to Sleep" campaign to prevent SIDS. While vital for reducing SIDS risk, this positioning means babies spend significant time on their backs, increasing the likelihood of a flat spot forming. This type of flattening is purely cosmetic and does not harm the brain.
Factors Contributing to Positional Flattening
- Prolonged Back Sleeping: The recommendation for babies to sleep on their backs is the primary reason for the increase in positional plagiocephaly. Consistent pressure on the same part of the malleable skull leads to flattening.
- Limited Head Movement: Conditions like torticollis (tight neck muscles) can cause a baby to consistently favor turning their head to one side, leading to an asymmetrical flat spot.
- Time in Restrictive Devices: Extended periods in car seats, swings, or bouncy seats, where the head is in a static position, can also contribute to the development of a flat head.
- Premature Birth: Premature infants often have softer skulls and may spend more time lying in a fixed position in the NICU, making them more susceptible.
How to Address Positional Plagiocephaly
For infants, several non-invasive techniques can help correct or prevent a flat spot:
- Tummy Time: This is the most recommended preventative measure. Supervised tummy time while the baby is awake helps strengthen neck muscles and takes pressure off the back of the head.
- Repositioning: When a baby is in the crib, alternate the direction you place their head to encourage them to look in different directions.
- Varying Holding Positions: Hold your baby frequently in different positions to reduce the time their head is resting on a flat surface.
- Limiting Baby Gear: Restrict time spent in infant carriers, swings, and other equipment where the baby's head is constantly in the same position.
A Rare but Serious Condition: Craniosynostosis
While most flat heads are not a medical concern, a rare condition called craniosynostosis requires prompt medical attention. This is a congenital condition where the skull bones fuse prematurely, which can restrict brain growth and lead to other complications.
Key Differences Between Positional Plagiocephaly and Craniosynostosis
| Feature | Positional Plagiocephaly | Craniosynostosis |
|---|---|---|
| Cause | External pressure on a soft, malleable skull | Premature fusion of one or more cranial sutures |
| Sutures | Open and healthy | Closed and fused |
| Effects on Brain | No impact on brain growth or development | Can restrict brain growth and increase intracranial pressure |
| Treatment | Non-surgical repositioning, tummy time, helmet therapy | Typically requires surgical intervention to separate the fused bones |
| Facial Asymmetry | Common, but usually mild | Often more pronounced and severe |
A pediatrician can usually differentiate between these two conditions with a simple visual examination and, if necessary, additional imaging.
What About a Flat Head in Adults?
If you are an adult with a flat head, it is almost certainly a result of untreated or partially-corrected positional plagiocephaly from infancy. Since the skull bones are fully fused and hardened by adulthood, positional changes are no longer possible. For most adults, a flat head is a cosmetic concern with no associated health risks. Some severe cases may involve a specialist, but for the majority, the condition is benign.
When to Seek Medical Advice
While a flat spot is generally harmless, consulting a doctor is important, especially if it appears severe or is accompanied by other symptoms. If you notice any of the following, a conversation with a healthcare professional is warranted:
- Your baby has an extreme flat spot or noticeable asymmetry.
- Repositioning techniques don't seem to be helping after a few months.
- Your baby has difficulty turning their head (potential torticollis).
- You notice any ridges or unusual head shape at birth.
Conclusion
The question, is it normal for the top of your head to be flat?, has a nuanced answer. For infants, a flat spot is a common, typically benign condition caused by sleeping and resting positions, and it often improves on its own with repositioning and increased tummy time. For adults, a flat head is almost always a harmless cosmetic feature from a condition developed in infancy. However, the rare but serious condition of craniosynostosis means any concerns about a baby's head shape should be discussed with a pediatrician to ensure proper diagnosis. For a deeper understanding of craniosynostosis, consult the expertise of medical professionals.
Children's National Hospital - Plagiocephaly
Common Methods for Addressing Infant Head Flattening
Repositioning and Tummy Time
This is the first line of defense for positional plagiocephaly, especially in the first few months when a baby's skull is most malleable. Changing the head's orientation during sleep and providing plenty of supervised tummy time while awake can work wonders.
Physical Therapy
If the flat spot is associated with torticollis, a physical therapist can provide specific exercises to stretch and strengthen a baby's neck muscles, helping them to move their head more freely and reduce the pressure on one area.
Cranial Remolding Helmets
For moderate to severe positional plagiocephaly that does not resolve with repositioning, a custom-fitted cranial helmet may be recommended. The helmet gently applies pressure to certain areas of the skull to redirect growth into the flattened spots. These are typically worn for a few months during infancy and have a high success rate. It's crucial to start this therapy at the right age to maximize effectiveness. Consult with a specialist to determine if this is the right course of action for your baby.
