My baby has flat head. What shall I do?
Question to Lucy Best, Orthotist, BSc (hons) SR Orth, MBAPO
Q: My GP said that the flat spot will go away by itself. Is this right?
A: Your GP is right for most babies: about 20% of infants aged 4 months now have some degree of flattening at the back of the head. In most cases, without a helmet, this will resolve itself by the age of 2 years. However, about 3% of children will continue to have flattening. That is about one child per school class. Heads with mild flattening will be quite noticeable on a small baby head and parents are often concerned, but as the head grows it will be less obvious especially with hair and at adult size it will not be noticeable even without hair. However, severe flattening on a baby head especially if the face shape is also affected, are at risk of being noticeable when the head is adult sized. Lucy will measure your baby's head to advise on the severity of the flattening.
Q: “Is flat head syndrome” just a cosmetic problem or does it cause brain damage?
A: Some studies show that children who displayed deformational plagiocephaly as infants have a slightly higher risk of requiring special education assistance at school. However it is now thought that it is not the plagiocephaly/brachycephaly that causes the delays but that the delays encourage the development of the cranial asymmetries. It is therefore a cosmetic problem only.
Q: Are there any concerns if the head is left untreated?
A: Apart from cosmesis, an unusual head shape may make fitting safety helmets (e.g. bicycle, motorbike, work hats, police/army helmets) more difficult.
Q: Does the helmet hurt the baby?
A: Babies often adapt to the band very quickly and it should not be painful. Any red marks are monitored by the parents and the helmet is adjusted as required.
Q: How is the helmet made to fit the baby?
A; Scanning technology is used to obtain a 3D image of the baby’s head. This is a quick and safe procedure. From this image a model is made which is used to manufacture the customised cranial band. Images are also used for recording the before and after shape.
Q: How do I know if my baby needs a helmet?
A: Making a decision to embark on Cranial Remoulding Therapy can be difficult and naturally causes anxiety for parents. Hampshire Orthotics Ltd offers a no obligation initial assessment for babies aged 3 - 15 months. During this time measures are taken to establish the severity and whether a cranial remoulding orthosis is recommended.
Q: What is the best age to treat?
A: The youngest is when baby has good neck strength and can sit (supported) with head remaining upright. This is usually around 3+ months old. In young babies, aged up to 7 months, the head is very mouldable and growing fast, so this is the ideal age for treatment and the time in a LOCband is only 3-6 months. For older babies, aged 8-18 months, treatment time takes longer 9 - 12 months and the correction may not be as good as with the younger babies. Lucy's advice is to try repositioning seriously for a month and if there is not much correction, don't delay and make an appointment to consider helmet treatment.
Q: What about physio, chiropractic and osteopathic treatment?
A: Many of the babies I treat see one of these health professionals in addition to the LOCband treatment and I believe a multiple team approach can only be beneficial (although there is no evidence to prove this yet). Find one that specialises in cranial work and babies.
Q: Can the helmet be painted?
A: Yes! I work with a very talented artist, Abi Jones. If you would like a custom painted helmet, it will be made in a dark grey colour and then once it is fitted you take it to her for the decorating. This makes the helmet experience so much more enjoyable for the parents and your baby will have a great keepsake afterwards!
Q: Will my baby need more than one helmet?
This is extremely rare, even with the most severe head shapes. This is because the helmet is made with a thick foam inner layer which is gradually ground out as the head grows. A second helmet is sometimes needed if there was a period of time not wearing the helmet, for example after a long period of illness, and the head changed significantly in that time. This is however very rare as your orthotist will do their very best attempt to get the original helmet to fit again.
Q: How many appointments will I need?
Around about 10 appointments are needed in total for the scanning, fitting and review/adjustment appointments.
Q: Will my baby's head get flat again after the treatment is finished?
Once the treatment is finished your baby will be older and much more mobile and sleeping less. The neck will be free to move and the head shape will be rounder, so there won't be a constant pressure on the original flat spot. The bones of the skull will be less mobile. Because of this, there will be a very low risk of the head shape flattening again. In babies that we have recalled after 6 months out of treatment, there was about 1mm of movement (better or worse). If a baby is still very young when the treatment is finished and the anterior fontanelle (soft spot on the top of the head) is still open and is still preferring to lie on the original flat area, we advise the helmet is worn during the nights and nap times until the baby is older. In this case, the helmet will need reviewing every month or so.
Q: What should I do now?
If you are worried about your baby's head shape, despite trying re-positioning, make an appointment to see Lucy for a no obligation measure of the head and chat. 023 8000 5505.