Safe Sleep: Plagiocephaly and Tips to Help Prevent It

In the Caribbean, where I grew up, it is common practice to put newborns down to sleep on their tummies.  I always knew this to be the norm, as it helps babies sleep longer. However, upon migrating to the United States, my eyes were opened to a whole new set of standards and practices endorsed by the American Academy of Pediatrics-- including the recommendation to put newborns to sleep on their backs.  This recommendation was first made in 1992 after back sleep was found to reduce the risk of SIDS (Sudden Infant Death Syndrome).

As a Professional Nanny working primarily with children 0-12 months, I wanted to make the investment in myself to learn all about safe infant sleep.  During one training, I was particularly curious and asked, “Won’t a baby’s head get flat from spending all that time on their back?”.  The instructor replied, “I believe the correct terminology you’re looking for, Ms. Morgan, is plagiocephaly, and yes, they can”.  After completing the training, I took it upon myself to do further research on this condition. 

Plagiocephaly, or “flat-head syndrome”, is a relatively common condition characterized by a flat spot on the back or side of a baby’s head. Plagiocephaly can be caused when the baby’s head frequently rests in the same position for long periods of time on everyday surfaces, such as mattresses, car seats, swings, or bouncers; it can even happen in the womb. It can develop in as little as one week and is present to some degree in nearly half of all infants.

Have you ever noticed that a newborn baby’s head flops either to the right or the left?  This is because babies are born with a preference for turning their heads to a particular side. Having worked with so many babies over the years, I’ve observed that most babies can’t hold their heads pointed forward. Research shows this is a result of the way they were positioned in the womb. 

In 2014, I was blessed to work with micro-preemies born at 24 weeks.  Twin A weighed in at a little over 1.5lbs and Twin B was just over 2lbs. They spent seventy-one (71) days in the NICU before being released, after which I had the pleasure of becoming their nanny. Upon meeting the twins for the first time, my heart skipped a beat out of fear that I wouldn’t be able to fulfill this position effectively. They were so tiny and I started second-guessing myself so much that I reached out to my former Mom Boss (MB), who reassured me of my strength and capabilities and said “If anyone can do this, I know it’s you, KimKim.  There are going to be challenges, but nothing I know you can’t handle”. There definitely were challenges, my biggest being plagiocephaly with mild torticollis. Twin A had severe plagiocephaly; I asked my current MB if she had spoken to the doctors about it and, if so, had she been given a prognosis? Her response was, “They didn’t seem too concerned about it”. I was shocked. To paint a mental picture, imagine a child’s hair in two pigtails and the entire back of her head flat. As time progressed, I noticed she would only lean her head to the right, or if I tried sitting her up, she would fall over to her right.  I immediately brought it to my MB’s attention and suggested she speak with her pediatrician. It wasn’t until then she was officially diagnosed with plagiocephaly and torticollis and was referred to see an occupational therapist. Occupational therapists recommend turning your baby’s head from side to side to avoid a flat spot forming and neck muscles tightening. Here are a few tips that can be used to help prevent plagiocephaly:

  • Turn baby’s head often in the first two months of life. Doing this will help baby develop their motor milestone of head-turning, because most newborns don’t have the strength and muscle control to hold their heads centered above their bodies for very long.
  • If you notice that a baby is always looking to the same side, gently position them so they are facing the other way; offer them black and white images to look at.
  • Gently turn baby’s head from side to side when they’re in a carrier, during tummy time (tummy time should be encouraged a lot), while you’re holding them, and when they’re awake on their back.
  • Don’t ever force a baby’s head to turn if it seems tight, and always refer parents to speak with their doctor if you have any concerns.

My love of children and passion for what I do has led me into the amazing world of Newborn Care Specialists-- a community in which I am so grateful to belong.  As a CACHE Accredited Newborn Care Specialist through Nanny Stella Inc. and Newborn Care Solutions, and a currently enrolled Y1 Elite Student in the Newborn Care Solutions Elite Program, I strongly believe these programs have allowed me to continuously develop my knowledge and skills in this arena and have ignited a passion for learning.  As caregivers with the all-important job of nurturing children, it is our duty to educate ourselves, remain current on the latest recommendations and guidelines, and apply what we’ve learned to educate parents and provide the best care possible, in the safest and healthy way.

Learn more about Plagiocephaly through our Master Class Mini-Course: Brachycephaly & Plagiocephaly

Kim K Morgan
Newborn Care Solutions Advanced NCS®, Certified Newborn Care Specialist, specialized in newborn care by CACHE, Parent Educator
International Nanny Association 2020 Nanny of The Year
Additional Articles by Kim:

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