Study shows flattening of heads among infants

Dr. Amber Hoffman, right, performs a well-child check on 2-month-old Christian Pacheco as Dr. Kate Robben looks on in Kansas City, Mo., on July 8. Christian did not show signs of a flat spot on his head, a problem becoming more common among infants.

When Sara Pacheco takes her 2-month-old son in for checkups, he gets all the measuring, weighing and stethoscope time you might expect.

But the doctor also carefully examines the shape of the baby’s head, looking for flat spots many infants develop after sleeping in car seats and on their backs for long stretches of times.

A Canadian study published Monday in Pediatrics, the journal of the American Academy of Pediatrics, found that of the 440 infants studied, almost half of the 2- to 4-month-olds had at least some flattening on their heads.

The condition, known as positional plagiocephaly, can permanently change facial features if untreated.

Since the academy in 1992 advised parents to have infants sleep on their backs to help prevent Sudden Infant Death Syndrome, the number of deaths attributed to SIDS has dropped by more than 50 percent. But more babies have been developing flat spots on their heads.

Elizabeth Simpson, a pediatrician at Children’s Mercy Hospital, said she sees a lot of babies with small flat spots on their skull. Because infants’ skulls are more malleable, they can change shape if a child lies in the same position too much.

Oftentimes these flat spots show up if parents use a car seat as a place to let their baby sleep or sit even when they aren’t driving.

“We tend to let happy babies stay put,” Simpson said. “So unless the baby starts crying, we’re liable to let them stay there.”

That’s where she comes in. When doctors notice one of these flat spots on a baby’s head, they coach the parents on how to prevent it from getting worse.

Usually spending more time holding the baby, switching up sleeping positions and making sure the baby spends some time lying on his or her stomach does the trick.

“It might be better for babies if car seats stayed in the car,” Simpson said.

Pacheco said she was never specifically coached on how to prevent her son from developing flat spots on his head, but it hasn’t been a problem.

“I always hold him a lot,” she said. “I lay him on his back and sometimes on his side.”

She said their pediatrician also talked to her about how important it is for her son to lie on his stomach, while he’s awake and being monitored, so his neck will get stronger.

This “tummy time” also helps prevent the development of flat spots, Simpson said. She said parents also can alternate which way the baby faces in the crib each night, which helps keep from putting too much pressure on one part of the head for too long.

About 3 percent of children have severe cases of plagiocephaly, Simpson said. In these instances, when the baby is about 6 months old, a neurosurgeon evaluates and decides whether he or she needs treatment.

This usually means wearing a helmet almost all the time for three to six months.

“If nothing is done, some of these kids can have permanent changes,” Simpson said. “Not only is there a flat spot on the back of their head, but one side of their face might protrude. One ear might be lower set.”

The study used data from four community health centers in Calgary, Alberta. It found that 47 percent of the infants studied had plagiocephaly.

Authors of the study suggest that doctors talk to parents about the condition before the 2-month well-child visit.

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