Give your baby 'tummy time' for much better head shape

Donya Betancourt, Pediatrician, drdonya@hotmail.com

In a doctor's clinic, discussion about a baby's head shape is a common topic.

Common questions include in what position should baby sleep? When is the head shape permanent? Is my baby's head flat? What can I do to make it look nice?

It has been recommended that babies should sleep on their backs to minimize the risk of Sudden Infant Death Syndrome (SIDS). This is a prudent course of action, but it has given rise to an unanticipated problem. When a baby sleeps only on his back, the growth and development of his skull can be adversely affected.

Let's start with the normal development of skull (head).

At birth, a baby's skull is not one smooth, hard bone. It consists of several sections of soft bone that can withstand the pressures exerted on it during birth.

If your baby was born vaginally, his or her head may be changed in shape (molded) during labor. It may appear flattened, crooked or elongated. Within 24 hours to 48 hours the head usually resumes a more rounded, normal appearance.

As you gently stroke your baby's head you may feel two softer spots, known as fontanel. The fontanel is where the four pieces of bone that make up the top of the skull have not yet grown together. One is toward the front (anterior) of the scalp, the other further back (posterior), toward the crown.

The size of the fontanel at birth is different in different babies. The large one (anterior fontanel) is nothing to worry about, and it is bound to be slower to close than the small one (posterior fontanel). The fontanel are there because your baby's brain grows dramatically during the first 18 months, more than doubling in size. To accommodate this growth, the bony plates (cranium) surrounding your baby's brain do not fuse together permanently until brain growth has slowed, at around 18 months.

The covering over the fontanel will gradually harden until the fontanel are completely filled in with hard bone. Parents worry unnecessary about the danger of touching the soft spot. Actually, it is covered by membrane as tough as canvas, and there is no risk of hurting a baby there with ordinary handling.

The top and back of a newborn's skull are very pliable. Because the baby's head is very soft in both the bone layer and the brain layer, it tends to deform somewhat like a bean bag, flattening at the back and front and widening on the sides as the skull and brain slowly collapse outward.

If the baby prefers lying on one side of the back of his head to the other, his skull can take on an asymmetrical, lopsided shape. If most of the flattening is at the back of his head, it may be covered by hair and barely noticeable. But if the shape of the front and sides of his head also are affected, parents are likely to notice and to worry.

Occasionally, parents become concerned after noticing that their infant's head seems flattened or asymmetric weeks or months after birth. The cause, known as positional molding, occurs when babies spend a lot of time lying in one position. As with so many childhood conditions, prevention is preferable to treatment.

Parents can minimize positional molding by the following:

* Hold your baby often or carry your baby in a front pack to relieve pressure on the back of the head.

* Don't put your baby in an infant carrier or car seat for a long period of time.

* Give your baby "tummy time", but only when awake and under observation.

* Alternate the end of the crib the baby uses. Put the baby down to sleep on its back at one end of the crib one week, then switch the baby around to the opposite end the next week.

* Position your baby to look in a new direction. Most babies will turn toward other people or noises. If you want the baby to look left, put all the stimulation on the left.

Parents usually observe a flattening of the head in babies in the first six to eight weeks of life. For most infants, flattening of the head is mild. It often becomes worse by four months of age. Then it can begin to improve and is often gone by six to seven months. It usually starts to get better around four months because that's when babies get better neck control and naturally want to spend less time lying flat. There's no clear clinical evidence that flattening of the head causes developmental harm.

There are many treatment plans for rounding out the head. Babies whose heads are very uneven can be referred to a specialist for an evaluation. Usually, these babies are first seen around four months to six months of age.

In severe cases, a specialist may recommend babies wear a helmet. This treatment best begins in the six to eight months range. The helmet reverses the process. It is larger than the child's head and is round. It allows the brain to grow against a round surface instead of a flat one. The best approach is prevention!