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Baby's Head Shape: What's Normal?

Babies' heads are malleable, which makes them susceptible to developing flat spots. It is easy and important to monitor your baby’s head shape. There are many treatment options available to your child if you notice a flat spot. There are also many ways to prevent flat spots from occurring.

Babies have soft skulls that tend to mold to the position they spend most of their days in. Babies sleep on their backs, which leads to the development of flat spots, most commonly on the back or sides of the head. Although this can often self-correct as they start spending more time on their tummy, sometimes it can progress and requires medical treatment to prevent permanent flat spots (head asymmetries).

The detection of an asymmetrical head is often associated with the baby’s preference to look in the same direction as the flat spot because it becomes the easiest position to rest their head in. This has a negative impact on the neck muscles, which become shortened on one side and overly lengthened on the other. Muscle imbalances of the neck can make it difficult for your baby to progress in movement milestones.

Head shape asymmetries are easier to treat when caught early. As soon as you notice a flat spot on your baby’s skull or a preference to look one way, you should contact your doctor and/or a pediatric physiotherapist. The gold standard treatment for head shape is through positioning advice and play-based exercises provided by a pediatric physiotherapist. This is best delivered before the baby starts spending most of playtime on their tummy. Once your child is not spending much time on their back, positioning strategies are limited in effectiveness due to them moving so often. Don’t worry if you don’t know how to monitor for a flat spot, most people don’t! The great news is, there are several treatment options once a flat spot is noticed, such as head shape helmets prescribed by a doctor or orthotist. Flat spot correction is mostly for aesthetic reasons, so bring it up with your doctor to ask if your child would be a candidate.

How do you check your baby’s head? If you have them supported sitting in front of you, look down on their head from above. Check if there are any sides flatter than the other or if there are bald spots from laying on one part of the head more often. You can also watch them throughout the day to notice if they prefer feeding or looking in one direction over another.

Can you prevent head shape asymmetries? Yes! There are a number of things you can do to minimize the chance that your baby will develop head shape asymmetries. Firstly, try to ensure your baby gets at least 30 minutes of supervised tummy time each day. If your baby doesn’t tolerate tummy time well, a pediatric physiotherapist can provide alternative positions to try that are appropriate for your child. Additionally, you can change the direction of their cot each night, as babies tend to turn toward their parent(s). Finally, you can play with them on the floor and bring their attention to both sides equally with toys, singing, and speaking to them.

If you’re unsure if your baby needs physiotherapy or would like some advice, it is recommended that you talk to your doctor or a pediatric physiotherapist. Head shape asymmetries are something that can be easily treated over telehealth platforms (video physiotherapy).

Catherine MacGillivray is a registered pediatric physiotherapist in Alberta and BC. She has a Master of Physiotherapy Studies from the University of Queensland and has worked with children across Australia, New Zealand, and Canada. Catherine provides pediatric physiotherapy over telehealth with Cairn Physiotherapy. To book an online appointment with Catherine, visit cairnphysiotherapy.ca.

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