When mom.me contributor Amy Klein’s 8-month-old daughter was diagnosed with “positional brachycephaly” (otherwise known as a flat back of the head), she felt guilty. As the mom confessed in her recent Washington Post essay, she had been putting her baby to sleep in a swing, which restricted movement and caused the flattening. Fortunately, the doctor who examined Klein’s daughter said the problem was entirely cosmetic and could be corrected with a helmet.
Although Klein had her reservations about the helmet, she and her husband went to see pediatric neurosurgeon Mark A. Mittler, who would be able to prescribe the device. Dr. Mittler confirmed the diagnosis of positional brachycephaly and reassured Klein that he sees patients “all the time with this problem,” which has become more common since 1992. That’s when the American Academy of Pediatrics launched its “Back to Sleep” campaign, urging parents to put newborns to sleep on their backs in an effort reduce the risk of sudden infant death syndrome.
What Dr. Mittler said next surprised Klein: Despite the diagnosis, he didn’t recommend a helmet. Helmet companies, he told her, have "really become an industry," charging thousands of dollars for the custom-made head gear. Although some babies may need one, it often isn’t the best solution.
In fact, a 2014 study in the British Medical Journal looked at 84 babies with flat heads (ranging from moderate to severe) and found no significant difference between those treated with helmets compared to those who received no treatment.
The babies who were treated with the helmets wore them for 23 hours a day for a six-month stretch, starting at the age of six months. By the time the babies were two years old, 25.6 percent of those in the helmet therapy group had made a full recovery, compared with 22.5 percent of those who had no treatment. The researchers point out that is not a statistically significant difference.
What’s more, parents whose babies wore a helmet reported side-effects that included skin irritation (in 96 percent of babies), an unpleasant smell (76 percent) and pain (33 percent).
For Klein, this study and the advice of Dr. Mittler were enough to turn her off of the helmet idea. The alternative solution?
“Our daughter needed to do as much tummy time as possible, which would help her develop her abdominal and neck muscles and would also take pressure off the flat spot,” wrote Klein, adding that as her little girl became more mobile and her brain grew, her head would grow, too, reducing the flat-head appearance.
In addition to tummy time (which should always be supervised), the American Academy of Pediatrics also offers these recommendations for preventing a flat head or halting its progress:
Change the direction your baby lies in the crib each week. This will encourage your little one to turn their head to alternating sides rather than resting in the same position all the time.
Similarly, when they're awake, vary the position you lay them down in and make sure they have something interesting to look at so you encourage them to turn their heads.
Avoid having your baby sleep in a car seat or bouncy seat for prolonged periods of time.