A HEAD'S UP
FLAT HEAD, AKA DEFORMATIONAL PLAGIOCEPHALY, IS ON THE MINDS OF MOST PARENTS
TODAY. HERE THE FAMILY GROOVE GIVES YOU THE LATEST ON HOW TO ENSURE YOUR BABY
IS SLEEPING SAFE AND SOUND

As a 37-year -old, I was part of generations of babies that slept on their tummies. My mother says she never gave
it a second thought: "Babies sleep better on their tummies," she told me. "SIDS was unheard of and, well, look at
your beautiful round head."  Well, that's one more thing for me to talk about in therapy, I guess.

The outrageously effective and rather hip Back to Sleep
campaign of the 1990s has changed many a mind on how
we safely put our precious nuggets down for a rest. Dr. Joseph Malak of TLC Pediatrics in Upstate NY says that before Back to Sleep, his practice would attribute one infant death per year to SIDS. Now he says, "We haven't had one in over 10 years.  But we do see a lot of bald spots and 'flat-heads' or plagiocephaly, at least one suspected case every few months.”

Accordingly to Wikipedia, plagiocephaly is a malformation of the head marked by an oblique slant to the main axis of the skull. However, more recently, the term has been used to describe any condition characterized by a persistent flat spot on the back or the side of the head. It's important to distinguish between an abnormal head shape caused by positioning or deformation and an abnormal head shape caused the early closure of cranial or skull sutures (where your baby's fontanelles come from) known as craniosynostosis. 
Studies abound that correlate the recent dramatic increase in the number of children with positional or deformational plagiocephaly with the Back to Sleep campaign.

It's an easy jump to conclude that since more children sleep on their backs, more will have some flattening of the back of their heads. And if a baby has a preference for sleeping with his or her head turned to one side or the other, this condition can be much worse and result in positional plagiocephaly. If the baby prefers his or her head to stay straight, then the back is more prone to flatten resulting in deformational brachycephaly (this condition refers only to a flattening across the back of the head).

Well, if you haven't run from the room yet to grab you little one and inspect his or her head with panicked gusto, there is some good news: prevention. At a baby's two-month well visit, Dr. Malak, amongst most in-the-know doctors, says he takes extra time to examine the skull because, "at  two months, you can prevent the progress of the condition with positive results." If any flattening is noted, your doctor will most often prescribe more tummy time for the baby while awake and supervised. Dr. Malak also suggests keeping the baby in a carrier (like a sling or mai tei) for naps instead of putting him or her down in a crib. Dr. Malak reminds us to periodically turn baby's head from side to side during slumber and to pay close attention to any changes in head shape that may occur. He adds that referrals from his practice to an orthopedist are rare, since most cases can be treated with the above modifications. Phew!

However,  if more intensive treatment is required, your child's physician may recommend a cranial remodeling band or helmet.  According to the experts at www.plagiocephaly.us: "Helmets are usually made of an outer hard shell with a foam lining. Gentle, persistent pressures are applied to capture the natural growth of an infant's head. The helmet essentially provides a tight, round space for the head to grow into."  The average length of treatment is three to six months, depending on the severity of the case.

In addition to your vigilance and the common sense, proactive approach of Dr. Malak, there are some products on the market that can also do a lot of good in the way of prevention. One of best on the market is an infant positioning bed called NightForm. This cool invention gives parents a myriad of sleep positions to choose for their baby. "Repositioning," says Phil Carter, one of the co-founders of NightForm, "is the number one proven method for preventing positional plagiocephaly." He goes on to say that "13% of all kids who are put to sleep on their backs has some form of plagiocephaly" and that he fully concurs with the prevention-is-best approach.

So be aware and be observant and, by all means, put your baby on his or her back to sleep. But don't fret because, as with everything else, good, attentive parenting is your baby's best defense.

*Note, we didn't address torticollis, (which is flattening that occurs due to muscle shortening on one side of the neck and impacts the positions a baby can hold its head in), in this piece. For more information on this disorder, go to www.infant-torticollis.org

For further information, go to www.plagiocephaly.org, www.plagiocephaly.us and www.nightform.com.

—Michele OBrien

Michele OBrien is the mother of two rockin' little girls and wife to one hip husband. A former Bloomberg TV exec, she's currently studying nursing and midwifery and is usually pretty exhausted.

*Photo by Suzanne Fogarty. To see more of her stunning work, go to www.suzannefogarty.com