by Amy Spangler
November 19, 2011
Since the launch of the Back to Sleep campaign in 1994, there has been an increase in the number of babies with flat spots on their heads, a medical condition known as plagiocephaly.
In 1992, researchers found that putting babies on their backs to sleep reduced the risk for sudden infant death syndrome (SIDS), the leading cause of death in infants between the ages of 1 month and 1 year. Since then, rates of prone sleeping (face down) have decreased from 75 percent to 11 percent, and rate of SIDS has declined nearly 60 percent. At the same time, there has been an increase in the number of babies with flat heads. One study assessed over 400 infants across the Canadian province of Calgary and found that nearly half—47 percent—had flat spots on their heads.
A baby’s brain continues to grow reaching 80 percent of its adult size around 2 years of age. To allow for this growth, the bones that form the head or skull are soft. They will eventually grow together and harden, which usually takes 12–24 months. If babies spend a lot of time on their backs, a flat spot can form on their heads, and little or no hair may grow on those spots. The flat area will disappear and hair will grow back once babies start to roll over, sit up, crawl, and walk. In rare cases, the baby’s head can become severely misshapen. If so, a special helmet, molded to fit the baby’s head, may need to be worn between the ages of 4 and 6 months.
Premature babies are more prone to getting flat heads. Not only are their heads even softer than those of full-term babies, but also preemies spend more time lying on their backs. Parents of preemies are encouraged to hold their babies skin-to-skin against their chest—a practice called “kangaroo care.” Research shows that kangaroo care helps to regulate breathing and heart rate and stabilize body temperature. Babies who are held skin-to-skin also gain weight faster and leave the hospital sooner.
But kangaroo care isn’t just for preemies! You can keep your full-term baby from getting a flat spot on her head by carrying her upright in a sling (much like kangaroo care) and putting her on her tummy when she is awake. (“Tummy time” will also strengthen the muscles needed for crawling and sitting.) Because the risk of SIDS is greater when babies are on their tummies, parents are encouraged to never leave a baby alone during tummy time. If you need to leave your baby alone, even for a minute or two, turn her onto her back. You can place her on her tummy when you return.
Continue to put your baby to sleep on her back during naps and at night. To reduce the risk of her developing a flat spot, alternate which direction you place her on the mattress. (Babies tend to turn their heads toward an object of interest, such as a mobile or a light source; by alternating her positioning, she may naturally change the direction of her head without you having to force her head to rest on any particular side.) Keeping her upright during the day, limiting the time that her head is against such hard and flat surfaces as infant car seats and swings, and giving her ample tummy time during playtime will reduce her risk of developing plagiocephaly.
Editor’s Note—December 6, 2011
The American Academy of Pediatrics (AAP) revised their guidelines for preventing and treating babies with flat heads (positional placiocephaly). A copy of the AAP report, Prevention and Management of Positional Skull Deformities in Infants, can be found in the December 2011 issue of Pediatrics.
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