EXPERT ADVICE: Does my child have a flat head?

Learn why your child’s head is flat and find out how this condition can be corrected.

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Making sure your baby sleeps on his back can prevent him from Sudden Infant Death Syndrome (SIDS) but it may cause him to develop Flat Head syndrome.

This syndrome comes in two forms: plagiocephaly and brachycephaly. In the former, the back of your child’s head is flattened on either the left or the right side. On the other hand, brachycephaly occurs when the back of bubba’s head is flattened. This often results in the head being widened, especially when seen from the front.

Common flat head syndrome causes:

* Sleeping position The most common cause of flat head syndrome is when baby favours sleeping on one side over the other side or on his back. If your child is less than 5 months, make sure to change his sleeping position regularly to prevent him getting flat head syndrome.

If your child is below than 5 months, make sure to change his sleeping position regularly to prevent him getting flat head syndrome.

* Wry (twisted) neck/Torticollis The neck muscles on one side of his body are shortened, so that your mini-me tilts his head more on one side.

* Craniosynostosis In this severe health condition, one or more of your infant’s bones in the skull or face fuse too quickly, which results in an abnormal head shape. He will also be referred to a neurosurgeon as surgery may be required.

Signs of flat head syndrome — both plagiocephaly and brachycephaly — can be spotted from as early as 6 to 8 weeks of age. Dr Kong Juin Yee, a consultant neonatologist at KK Women’s and Children’s Hospital, says the flattening of your child’s head will likely stop once he gains better control of it — typically at around 3 months of age. Infants aged 6 months or older may need to wear a specially-designed helmet to reshape the head. Dr Kong answers questions about the condition…

What are some tests carried out to determine if my child has flat head syndrome?
A careful patient history is taken from the caregivers and thorough physical examination is usually done to test for flat head syndrome that occurs due to sleep positioning. On the other hand, flat head syndrome that is caused by craniosynostosis may need X-rays, ultrasounds or even a 3D computerised tomography (CT) scan of the head to confirm the fusion of baby’s skull bones.

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How can parents help their kids avoid developing the condition?
Parents can help prevent the condition by alternating their baby’s head from left to right from time to time when putting them to sleep on their backs. While awake, they should encourage “tummy time” on a firm flat surface — placing items such as a small blanket roll under the baby’s shoulders to help him overcome gravity and lift his head. During feeding, babies should be held interchangeably on each arm to avoid putting pressure on a specific side of the head. So, infants should lie, play, feed, and be carried in a variety of positions.

“Parents should should encourage ‘tummy time’ on a firm flat surface.”

Are there any risk factors that may cause a baby to develop plagiocephaly?
An infant who prefers turning his head to one side may cause asymmetric flattening of that side of the head. Some conditions are associated with skull demineralisation — the process where bones and teeth absorb minerals such as calcium and phosphorus. Examples include osteogenesis imperfecta ― brittle bone disease — or hypophosphatasia — a rare genetic disorder where there’s an abnormal development of bones and teeth — which can lead to severe flattening of the back of skull.

Can foetuses develop flat head syndrome in utero?
Yes, flat head syndrome can develop in the womb. It is more common in babies who are part of multiple births — like having twins or triplets or when a mother has a smaller womb. The restrictive space in the uterus, especially during the last trimester of pregnancy, leads to flat head syndrome. So, babies who are twins or triplets are also at a higher risk of plagiocephaly.

Any long- and short-term health issues that can result from plagiocephaly?
Flat head syndrome from sleeping positions usually causes short-term cosmetic problems and usually resolves by 2 years of age, sometimes needing help from physiotherapy or use of head bands or helmets. Flat head syndrome from craniosynostosis not only affects the cosmetic appearance of the child, it could also result in increased pressure inside the skull and damaged brain growth if the skull does not expand enough to make room for the growing brain.

GET TO KNOW OUR EXPERT…
Dr Kong Juin Yee is a consultant neonatologist at KK Women’s and Children’s Hospital.

Photos: iStock

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