Luckily, baby heads are moldable. An infant's skull is made of moveable plates so the baby can travel through the birth canal. In between these plates are spaces (or fontanelles) which allow the skull to expand so the brain can grow. And the brain grows rapidly. If a baby's head always rests in the same spot, the skull bones or plates become flat. Unfortunately, a flat spot can develop rapidly. Research has shown that positioning is the most effective tool to decrease a flat spot. And the window for improvement is extremely wide because a baby's head shape can change up until she is 18 months of age.
If your baby has trouble changing it's head position or you notice a common pattern (for example, my baby will only turn to his right), he may have a tight neck muscle, also known as torticollis. It is important to see a pediatric physical therapist. Torticollis doesn't always resolve on it's own and your baby would benefit from more intense stretching and positioning activities under the guidance of a PT. It is important to talk to your pediatrician when you first notice a flat spot or neck preference. Many parents tell me that their pediatrician didn't seem overly concerned in the beginning. Be an advocate for your baby and request a referral to a pediatric physical therapist before four months of age. Younger babies generally tolerate stretching better and the results are more dramatic.
Here are some simple tips to prevent flat spots:
More tummy time! You got it! -- Tummy time should be always be supervised and can start immediately after birth. Start by placing your baby on your chest. By six months of age, babies should spend more than 80% of their waking hours on their tummies. Research has also shown that babies who spend more time on their tummies have advanced motor skills.
Change your baby's position -- Change the direction your baby lies in her crib each week. If you have toys or mobiles, consider placing them on different sides of the baby. They don't always have to be directly overhead. If you notice a head or neck preference, place something exciting (toys, people, mirrors) to the side that is more difficult for the baby. Carry the baby so he has to turn toward the more difficult side to look out at the world.
Hold your baby -- If a baby is being held, it can't spend time on the flat spot and the flat spot won't get worse. Hold your baby upright over your shoulder. Use a baby carrier.
Avoid prolonged time in baby containers (car seats, bouncers or swings) -- babies who sleep for longer periods of time in containers are also at higher risk for unusual head shapes because they can't actively change their position. Try to limit the time your baby spends in a car seat to travel only or short naps. Similarly, don't let your baby sleep in a bouncer or swing.
And don't forget to do your tummy time! Supervised tummy time is the best position for helping your baby improve it's head and upper body strength while also maintaining that perfect head shape.