Q: My five-month-old son’s head looks a little flat on the back. How much is normal? Should I be concerned about his flat spot?
A: Sounds like classic positional plagiocephaly, which sounds awfully serious, but is in fact very normal in the vast majority of cases. The Back to Sleep campaign has been a fantastic success in that almost all parents now place their infants on their backs to go to sleep, which has been shown to decrease the risk of SIDS (crib death) dramatically. But…as a byproduct, infants are now often developing a little flattening at the back of the head because the skull is still soft to allow for the rapid growth of the brain and it ‘moulds’ if spending a lot of time in one position. Some babies may have a bit of limitation of neck movement on one side (torticollis) associated with this. In the vast majority of cases this will sort itself out without any intervention as your baby learns to sit up.
It is a good idea for all infants to have quite a bit of tummy time when awake for developmental purposes, and this will help the flat head problem. Alternating sleeping position in the crib from time to time (kind of like rotating the tires on your car) to encourage turning the head to the left and right can be helpful. Very rarely the flattening is so extreme and noticeable that infants are seen by a craniofacial specialist and placed in an individually moulded helmet, but this is hardly ever necessary.
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