Babies with a crooked and flat head

Symptoms of a crooked/flat head

Typically, you will observe that the infant’s/baby’s head is crooked and asymmetrical.

Especially when viewed from above, the head is often described as a parallelogram rather than as having symmetry.

Typically, you can observe that the child is missing hair on the side of the head where they have primary weight. Similarly, a crooked back of the head can often be spotted by the ear on the “flat side” appearing to be pushed further forward, just like the forehead.

Causes of a crooked and flat head

It is recommended that infants sleep on their backs, as this has been shown to reduce the risk of “sudden infant death syndrome.” If the child lies on their back a lot, especially during waking hours, it can be a contributing factor to the development of a flat back, as the skull, as previously written, is flexible.

In some cases, the child may have a restriction in the neck, where a joint does not have complete freedom of movement. Something we treat at Osteonordic, among other things.

In that case, it will be natural for the child to have a preference to always turn his head to the same side when lying down, which can cause the child to develop a crooked back of the head, for example, if he always only looks to the right. This condition is also called positional plagiocephaly. Similarly, torticollis, where a tight neck muscle is present, will cause the child to have a preference to turn his head to one side.
​
Some babies have a crooked head at birth if they have been pressed into the mother’s pelvis, or if there has been a twin so the space has been tight. A difficult birth with a suction cup and the like can also cause a crooked head.

​

What should parents be aware of?

If you have a premature baby (born too early), you as parents should be extra aware of a flat/crooked head, as premature infants have an even softer skull, and some of these children have medical needs that make them more prone to supine positions than usual, and thus more prone to a crooked/flat head.

Likewise, as parents, you should pay attention to whether your child tilts their head to one side and looks to the opposite side (e.g. right ear lies against the right shoulder and looks to the left).

In such cases, it may be torticollis, where it is classic that one neck muscle is too tight and holds the head in position.

In this case, manual therapy will be indicated to work with the neck muscles and their relationships mechanically and neurologically, thereby allowing the child to straighten their head to a normal position.

Prevention of crooked/flat head

Since a crooked/flat head is most often caused by a lot of time spent lying on the baby’s back, it is important to minimize this to the extent possible. It is of course important that the guidelines and recommendations from the Danish Health Authority that the baby should sleep on their back are followed, to reduce the risk of SIDS.

What parents can do to prevent a crooked/flat head include;

• • Place the baby on his/her stomach when he/she is awake – this also stimulates motor development, strengthens the muscles around the back/neck and helps with the development of the stomach/intestinal system as it stretches the front of the body.

• • Watch your child when they sleep, and be aware that the child does not always lie with their head to one side. In some cases, this is due to a restriction of movement in the neck, which is why it is beneficial to seek manual treatment if the child consistently only seeks the same side.
    

    ---

  • If the child has a tendency to have a flat head, they should be positioned so that they “lie” with their head on the non-flat part/side of the head.

• • The more you can distribute the “pressure” on the skull during the day, the better. So think about whether you as a parent can help turn the child’s head into sleeping positions, whether in the car seat, in the sling or in the carrier.

• • Change arms frequently when carrying the baby around, so that it looks to both sides – the same applies if the baby is lying on your arm. This means that you should stimulate the baby to look to both sides.

When should parents seek help?

• • There is a single diagnosis called craniosynostosis, which causes a crooked head/skull. The condition involves one or more of the sutures between the different skull bones having “fused together” prematurely, which means that the child’s head will develop crookedly, regardless of pressure on the skull. Normally, this will already be apparent at birth. The condition is seen in 1 in 2,000 newborns, and if suspected, referral is always made to children’s departments, where a decision is made as to whether orthopedic surgery is necessary.
    However, as described on this page, the vast majority of cases of crooked/flat head are due to pressure on the skull, as babies, especially in the first months of life, lie down a lot and have pressure on their heads, i.e. a position-related crookedness of the head (positional plagiocephaly).

• • If you as a parent notice that your child’s head looks crooked/asymmetrical, it is always a good idea to consult your doctor, a child/baby health visitor or osteopath who deals with child/baby treatment, as well as other relevant health professionals. Typically, it is easiest to observe asymmetry when looking at the head from above as previously described.

• • If you experience that your child has a tendency to torticollis, where the neck muscle on one side is tight, you should seek out an osteopath or other manual child therapist. In this case, the child will have their head tilted to one side and look to the opposite side.

• • If you experience that the child has a preference for turning the head, so that you always find the child spontaneously with the head turned in a certain direction, it is a good idea to have the child examined to see if this could possibly be due to a locking in the neck.

Treatment of crooked head/flat head

Traditional treatment in some countries consists of “helmet therapy”, where by putting a helmet on the child, an attempt is made to facilitate a symmetrical head shape.

Surgical treatment of the skull is only necessary in rare cases if craniosynostosis is detected (1 in 2,000 babies).

Osteopathy and crooked head/flat head

Osteopathic treatment of babies/children always aims to look at the whole baby. Thus, as an osteopath, you take the whole “system” as your starting point.

As mentioned earlier in the article, a large part of treating a crooked/flat head is to reduce pressure on the baby’s head by varying the load.

Thus, as parents, you have a good opportunity to influence a process where you work with the treatment of a crooked/flat head.

Among other things, osteopaths treat crooked/flat head by:

• Craniosacral therapy and techniques from it. Thus, work is done locally around the skull to reduce any tension around the sutures, so that there are no restrictions that minimize the possibility of free movement of the skull bones in relation to each other.
• To investigate whether there are movement restrictions in the neck that cause the child to have a preference for head rotation, and treat these restrictions using gentle mobilization techniques to ensure free movement of the neck.
• To examine for locking in the back that influences neck mobility.
• Treat tension around the gastrointestinal system that may be the reason why baby does not want to lie on his stomach.
• To treat the skull for tension that may affect the nerve supply to the neck muscles, which may be the cause of a preference for head rotation for the child.