Paediatric Dietitians – referral criteria
Babies sometimes develop a flattened head when they’re a few months old, usually as a result of them spending a lot of time lying on their back.
This is known as flat head syndrome, and there are 2 main types:
- plagiocephaly – the head is flattened on one side, causing it to look asymmetrical; the ears may be misaligned and the head looks like a parallelogram when seen from above, and sometimes the forehead and face may bulge a little on the flat side
- brachycephaly – the back of the head becomes flattened, causing the head to widen, and occasionally the forehead bulges out
These conditions are quite common, affecting around 1 in every 5 babies at some point.
In most cases they aren’t a major cause for concern, it is considered more of a cosmetic issue than of a medical concern as they don’t have any effect on the brain and the head shape will often improve by itself over time.
Important things to consider include:
- Is the baby always sleeping on their back (note: this is recommended to reduce likelihood of SIDS)
- Being born prematurely (premature babies are more likely to develop a flattened head)
- Neck muscle tightness (torticollis) – this can prevent a baby turning their head a particular way, meaning one side of their head is placed under more pressure
- Occasionally flattened head can be caused by early fusion of sutures of the skull (craniosynostosis)
- Early fusion of sutures (craniosynostosis)
- Abnormal head shape at birth
- Uneven facial features or other facial defects
- Static head circumference
- Flattening of the head first noticed before 2-3 months of age
- Developmental delay (motor, language)
- Seizures (if currently having a seizure, call 999)
The shape of the baby’s head should improve naturally over time as their skull develops and they start moving their head, rolling around and crawling.
We give the following advice to parents to take pressure off the flattened part of the baby’s head:
- Encourage time on their tummy during the day (but sleeping on their back)
- switch the baby between a reclining chair, a sling and a flat surface – this ensures there isn’t constant pressure on one part of their head
- change the position of toys and mobiles in their cot – this will encourage the baby to turn their head
- alternate the side you hold your baby when feeding and carrying
- reduce the time the baby spends lying on a firm flat surface, such as car seats and prams – use a sling or front carrier when practical
In addition, the following may help:
- If the baby has difficulty turning their head (torticollis), physiotherapy may help loosen and strengthen their neck muscles. Physiotherapy can be accessed via ERS referral.
- There is no clear evidence to suggest that specially designed helmets and headbands work, and we therefore, cannot supply these on the NHS.
Babies with static head circumference, or suspicion of premature fusion of the sutures should be referred urgently to paediatrics. Rapid access referrals can be sent via ERS marked as ‘urgent’
In first seizures (but not currently fitting), a referral to the first fit clinic can be made via ERS. Any child under one year of age with a non- febrile seizure should have urgent assessment and can be referred urgently to PAU via switchboard.
For other ‘Red Flags’, or in cases where parents need paediatric assessment for reassurance, please refer to General Paediatrics via ERS, with information on head circumference (including trend) and development. If you wish to discuss the need for referral, or urgency, please use Advice & Guidance on ERS in the first instance for discussion with a Consultant.
The following may be useful information for parents:
Plagiocephaly and brachycephaly (flat head syndrome) https://