Plagiocephaly: how to prevent flat head in the newborn

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La plagiocephaly (or flat head) is when the baby has a flatter head on one side than the other and is caused by the position in which the baby is put to sleep. 

In summary, his skull has taken the shape of a cradle or cot. As he states Doctor, specialized in emergency pediatrics and French author of the book A pediatrician for a friend (Mondadori), in bookstores from 20 July 2022, the child's skull is a bit like planet Earth: there are different tectonic plates and areas where they are welded, so they move. 

It is the reason for the so-called "Drinking fountains" and sutures where the different plates of the bone will bond once the brain has stopped growing.

In this article

  • Plagiocephaly and craniosynostosis, how to distinguish
  • Plagiocephaly, tips to prevent it
  • Things not to do
  • Two things to know

Plagiocephaly and craniosynostosis, how to distinguish

First step to address this fear: distinguish between plagiocephaly e craniosynostosis.

It goes without saying, although it is very rare, that in some newborns there may be sutures that close prematurely! 

It is therefore necessary to distinguish the plagiocephaly caused by the early fusion of a suture (or craniosynostosis) and le positional plagiocephaly (because the child holds his head more on one side than the other or has a stiff neck!).

  • When a newborn has a deformed head from birth, it is likely to be one craniosynostosis.
  • On the other hand, if the skull is deformed one month after birth, then it is one positional plagiocephaly, because the child has a tendency to look too far to the right or left.

We will therefore talk about the concern of parents: the positional plagiocephaly, also called PP. Craniosynostoses are the responsibility of pediatric neurosurgeons.

Read also: Craniosynostosis: what they are, what they involve, how to intervene

Plagiocephaly, tips to prevent it

According to Toubib, if some believe that PP is a consequence of modern rules that require babies to sleep on their backs to prevent "cot death", the essence of the problem is not here. It is useless to question those rules, because if they avoid the risk of SIDS, they are welcome.

The point is that PP is a consequence of the child looking too often to the right or too often to the left. What to do then? You will therefore have to stimulate your baby as much as possible. 

The first cure for PP (both to prevent its occurrence if your child holds his head too far to one side, and to heal it if it has already established) is positioning. When your baby has PP (whatever the severity), steps need to be taken to make him look the other way! Here are six tips from Doctor Toubib.

  1. The British, for example, have invented something very useful: tummy time (literally, "time on the belly"). It consists in putting the baby on his stomach for 10-15 minutes 3 times a day, not only to stimulate motor skills, but also to make him discover the freedom of movement in the neck. Yes, yes, it has been said: it is forbidden to put him on his stomach ... but only when he is asleep!
  2. Since the crib or bed is usually placed against a wall, it is recommended to point the baby's head towards the head or the foot of the bed every other day. On Monday you make him sleep with his head on the foot side of the bed, Tuesday the other way and so on! He won't get seasick, just rest assured, and put something bright, colored or sound on the opposite side of the flattened side of the skull to get his attention.
  3. When you have it in your pouch, let him rest his head on both sides. Ditto when he sleeps: make him turn his head without straining it to the opposite side for up to 2 months.
  4. Get a baby gym as soon as possible (from the very first months). The gym is the Good. Thus the baby explores his freedom of movement and can, once again, discover his own motor skills. Also put some toys in it to get him to move, and don't place the multi-activity arc directly above him, so as to force him to turn his head!
  5. Alternate the position during breastfeeding or bottle feeding, attracting his gaze as he passes from one to the other. In short, make him move his head so as not to always leave it on the same side every time you feed him, change it ... at every opportunity!
  6. When he sleeps like a log, it must be on a firm mattress, without a pillow, with nothing under your head, with appropriate sized sheets or sleeping bags.
Read also: Health balances, what they are and when to do them

Plagiocephaly, what NOT to do

  1. Do not use a flat head cushion or positioning cushion. They are downright dangerous. Only a specialist (neuropedologist or neonatologist) can prescribe them.
  2. Avoid the bouncer, the canopy or other positioning devices. Generally with the older ones they use an hour and a half a day, but for the newborn forget them. You sleep in a bed.
  3. Do not place the mobile directly over the baby. Otherwise you will force him to stay with his head in the same position! Instead, place it at the edge of its field of view and change the position of the mobile often.
Read also: The newborn has a 'flat head': what to do?

Plagiocephaly, two things to know

  1. Do not confuse the role of the osteopath and that of the physiotherapist. In some children, a stiff neck also causes PP, because they tend to always be on one side rather than the other. To cure them, after having them examined by a doctor, physiotherapy is needed as quickly as possible and at least 3 times a week. To know what to think of osteopaths, just know that the health authorities have not yet specified what the official training and professional profile of the osteopath must be in order for her to work in the national health service. For the moment, therefore, osteopathy does not play a role in finding a solution to a child's stiff neck, even if there is no formal prohibition… It is up to you to decide, at your own risk.
  2. Beware of helmets or orthoses for cranial reshaping: currently, the helmet is expensive, is not reimbursed by the mutual or health insurance, has no proven efficacy in the long term (ie 2 years of life), is constricting and has side effects on the skin. The only serious studies on the subject indicate that there are no differences between the results obtained with the positioning technique and that involving the use of the helmet. Hence, the helmet is not necessary. Helmets should only be considered for severe plagiocephaly, after seeking the advice of a neurosurgeon from 6 months of age.
Read also: Fontanelle of newborns

A pediatrician as a friend

Toubib, author of the book A pediatrician for a friend (Mondadori Electa), is a doctor specializing in emergency pediatrics. In 2022 he created the very popular page Facebook To be or not Toubib with the aim of offering clear and concise medical information to parents whom he sees too often frightened arriving at the emergency room.

The book A pediatrician for a friend, which will be in bookstores from 20 July 2022, has the same ambition: to allow mothers and fathers to face the daily ailments of their child from 0 to 16 years, remaining lucid but knowing when to worry. 

Sources for this article:

Toubib, A pediatrician as a friend, Mondadori Electa

Toubib, "A pediatrician as a friend" (Mondadori)

  • health and children
  • craniostenosis
  • newborn development
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