Repositioning your infant off of the flat spot helps promote symmetrical cranial growth! Research shows that repositioning is an effective and recommended strategy for plagiocephaly (head asymmetry) up until a certain point. Many of our families start to struggle with repositioning efforts as babies get older and always welcome new ideas. We know that as your baby becomes more active, at 4-6 months of age, repositioning is not as effective because your baby is now able to reposition themselves. As your little one becomes more active, the risk for flattening is less but so is the likelihood for correction without the helmet. To get your little one up and off the flat spot as soon as possible, see these recommended strategies below. For more information on what the flat spot is exactly, see our post "What Is A Flat Spot?"
Your baby has preferences for sitting, eating, playing, and sleeping, just like you and I! These preferences and other pre/post- natal factors could lead to conditions like plagiocephaly and torticollis. Some flattening is present from birth however in some cases, flat spots and develop in the first few weeks due to how we position and routinely handle our baby. In some cases of plagiocephaly, a helmet is needed to get full correction, but there are many ways you can position your baby to assist with cranial development and possibly avoid a helmet!
While it is sometimes possible to avoid a helmet with repositioning, a helmet is the necessary answer to continued plagiocephaly. The helmet should not be viewed as a negative result of "failed" repositioning. If you can avoid the helmet awesome! If you continue to struggle with repositioning or you are doing well with repositioning and your little one's head is still flat, we are here to help!
What Is Positioning?
When we use the term positioning, we just mean all the ways in which your baby sits, lays, or is carried. Placing the baby in different positions throughout the day can benefit their growth by rotating the pressure points around their head. When we recommend "repositioning" we specifically mean being conscious of moving your baby off of a preferred flat spot and repositioning them. Before we get into some of our suggestions for positioning, please know that your baby should be comfortable! We never want you to place your baby in a position that makes them cry unconsolably.
There are many different ways you can carry your baby to help reduce the amount of pressure on their heads. By pressure, we don't mean headaches or inter-cranial pressure! We are talking about an external surface like mattress or swing that interrupts symmetrical cranial growth. Babies love to be carried and this also helps them have their head in a variety of positions against a variety of surfaces. As previously mentioned, we parents tend to do what is most comfortable for ourselves when carrying our baby. We also frequently keep our dominant hand free in order to feed baby, grab a diaper, or turn on the light while carrying baby. It is important to keep our baby's head position in mind and alter our routine handling to prevent a side preference.
Facing baby out or placing her in a carrier can help reduce the amount of pressure on the sides and back of the head. If baby does not have full head control yet allow them to ‘lounge’ back on your chest or use your hand under their chin to support their head. If your baby has full head control, place one of your hands under the baby’s bottom and the other hand across their chest so baby can be supported while practicing head control.
Holding your baby on their side removes pressure from the typical areas of plagiocephaly and also helps to stretch baby’s neck muscles to prevent torticollis. Place one arm between your baby’s head and shoulder with your hand on their chest and the other hand under your baby’s legs/bum area. You may also place your second arm between their legs to keep them well supported.
If your baby already has a flat spot on one side, it may be difficult for them to turn their head in the other direction. They may also sleep in one position because it's easiest or simply because they like to face you as they fall asleep.
One of the simplest tricks to get your baby turning away from their flat spot is to flip them around in their crib so they will choose to face you (instead of the wall).
You can also try placing a small wedge pillow under the side of the mattress that they typically face. This slight angle will make it easier for your baby to turn to their nonpreferred side and therefore provides pressure relief to their flat spot.
If your baby still doesn’t want to look in the other direction while sleeping, you can place a small blanket or burp cloth under their head. When they fall asleep, gently lift one edge to slowly turn her head in the desired direction. Only use this technique when you are able to check in on your baby frequently to make sure the blanket is still in a safe location (such as during nap times).
Did you know that a baby with right-handed parents is more likely to have a flat spot on their right side? This is because it’s usually more comfortable to support your baby’s body weight with your non-dominate hand and your baby likes to turn to the right to look up at you. Try switching your baby’s direction every time you feed to help even things out.
Alter your feeding position even more by moving your elbow back and resting your baby’s head in your hand. Having baby's head in the natural curve of your hand will help disperse pressure evenly throughout the back or side of your baby’s head.
Setting them on a nursing pillow or in a highchair to feed them is another great way to change the types and amounts of pressure on their head. Your baby may choose to rotate their head differently on the pillow than on your arm, which is great for varying the types of pressure on their head.
Did you know you can start tummy time as soon as you take your baby home from the hospital? It’s a great way to help your baby strengthen their neck and core and also assists in the treatment of plagiocephaly! If your baby is new to tummy time you can introduce this position by laying on your back and placing baby on your chest so they can look at you. Babies under 3 months of age might not hold their own head up yet, so you can turn their head to the side.
The purpose of tummy time at their age is simply to get them used to the feeling of being on their stomach. If your baby has head control but is struggling to hold themselves up, place a small pillow under their chest. This encourages them to play in a tummy time position without getting too tired. When this becomes too easy, or they start lifting themselves up from the pillow, you can start to incorporate more tummy time on the floor without the pillow! Start with 3-5 minutes at a time and slowly build up from there. We recommend doing a few minutes of tummy time each time change your baby’s diaper to get them used to being in this position.
As soon as your baby is able to sit up on their own, try to do as much as possible from this position! When your baby is sitting, there is no pressure on their head and their little skulls are able to grow evenly in all directions. Sitting up also strengthens their neck, back, tummy, and hips; all of which are needed for standing and balancing later on. Walkers and bouncers are also a great way to relieve pressure from your baby’s head, once they have neck control. Just like sitting, crawling, and standing, it removes all areas of pressure from their little noggins. For developmental considerations with walkers and standards, see this article from Hello Motherhood.
When your baby tries to start pulling themselves up to stand, make sure they have a safe and sturdy surface to grab on to! You can place toys on top of these surfaces so they receive a reward for working so hard. Make sure you always supervise these activities to prevent your baby from falling and getting hurt.
With all of these positions remember that if your baby doesn’t like something they will tell you! We know that your baby rules your house and your sleep, so we want to make sure everyone is comfortable and liking the positions you use on a regular basis. If you don’t think that repositioning is helping the shape of your baby’s head, call us to make an appointment for a free evaluation!
Editor Kaitlin Ploeger OTD
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