It's On the Rise
Doctors are seeing more and more cases of positional plagiocephaly. Today, it affects one in 60 babies, compared with one in 300 in 1974. Parents notice that their baby has an oddly shaped head with a flat spot on the back or one side and that their child's facial features or ears are asymmetrical. "While plagiocephaly is not life-threatening and doesn't affect brain development, it can lead to improper skull growth and permanently affect the symmetry of a child's face if it isn't treated properly," explains John Persing, M.D., a craniofacial surgeon at Yale–New Haven Hospital, in Connecticut.

Some infants are born with plagiocephaly because of cramped quarters or positioning in the uterus, while others develop it owing to torticollis, a tightening on one side of the neck muscles that causes a baby to favor looking in one direction over the other. Experts believe that the recent jump in cases, however, is the result of the "Back to Sleep" campaign introduced in the 1990s to reduce the risk of sudden infant death syndrome. While this program—which encourages parents to put their babies to sleep on their back rather than their stomach—has been widely credited with cutting the number of SIDS deaths by 40 percent, it's also led to an unfortunate side effect: plagiocephaly. Since an infant's skull is soft, it can easily be molded by external pressure from a firm mattress.

Some Babies Are At Higher Risk
Misshapen heads are most common in premature babies, since they tend to have softer skulls than full-term infants. (Ryan was born a month early.) Multiples are also more likely to be born with slightly deformed skulls because they are often cramped in the womb.

Parents Can Help Prevent Plagiocephaly
"First of all, you should always put your infant on his back to sleep—don't put him on his stomach because you're worried about a flat spot," says Dr. Persing. "The key is to alternate the position of his head each night." In other words, turn it to the left side one night, the right side the next. Be sure to do this at naptimes as well. In addition, give your baby plenty of tummy time during the day, starting when he's 2 or 3 weeks old. Simply place him belly-down on your chest or across your lap for a few minutes several times a day to get him used to the position. At three months, put your baby on a thin blanket on the floor for several five- to ten-minute sessions while you watch. (Tucking a small, rolled receiving blanket under his chest may make him more comfortable and better able to look around.) Finally, try to minimize the amount of time your baby spends in car seats, bouncy seats, or infant swings during his first 6 months—or use a soft headrest to adjust the position of his head so that the same part of his skull isn't pressed against the seat day after day.

Diagnosing Problems Early Is Vital
Many babies have slight skull imperfections as a result of traveling through the birth canal, and most of these problems will correct themselves within the first 6 weeks of life. But if your baby's head doesn't improve—or if the flattening seems noticeably worse—talk to your doctor about getting a referral to a pediatric neurosurgeon or craniofacial surgeon. Sometimes, using mobiles and toys to coax a baby to turn his head will do the trick. In more severe cases, the only option is a cranial band. The band, which has a hard plastic exterior and foam interior, guides the head's growth and allows the flat part of the skull to expand and round out. The earlier plagiocephaly is treated, the better, since head growth slows as a child ages, which makes correcting the shape more difficult.

The Band's Not as Bad as It Looks
I'll admit that sometimes it's difficult to deal with children's stares or people asking whether Ryan had brain surgery. But other than that, the cranial band has been easier to deal with than I expected. Ryan wears the band for 23 hours a day (it comes off only for bathtime); it has to be refitted—which is done by shaving a part of the foam interior to allow room for growth—almost every other week. (The band and fittings cost around $3,000; most or all of this is usually covered by insurance.)

At first, we were concerned that Ryan would constantly try to take off the band. But he managed to adjust to it within a day and usually doesn't even seem to notice he's wearing it. While most babies use a cranial band for an average of four months, Ryan—who is now 11 months old—will probably wear his for at least six. However long it takes, we don't care—we've already noticed a huge improvement in Ryan's head. In fact, the flat spot is almost gone!

Learn More on the Web
Does your baby have a suspicious flat spot—or do you want to learn more about tummy time? Log on to these sites: