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Back-Sleeping Babies Risk Flattened Head

Experts Say the Condition Is Easily Prevented
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WebMD Health News

July 8, 2003 -- Infants who sleep in the same position each night or spend too much time in car seats are at risk for developing flattened heads, but the nation's largest group of pediatric specialists says the condition is easily prevented and easily treated if caught early.

The American Academy of Pediatrics (AAP) is reporting an increase in the number of children with flattened skull deformities since the early 1990s, when parents were first told to place sleeping infants on their backs to minimize the risk of sudden infant death syndrome (SIDS).

Infants should still sleep on their backs, the experts say, but the position of their heads should be alternated nightly. Other AAP recommendations to reduce the risk of flattened heads include:

  • Periodically change the baby's orientation in the crib so that his attention is not always focused in the same direction. If the baby is always looking toward a door, for example, change his position so he will have to turn his head a different way to see it.
  • Place the infant on her tummy for certain periods during the day while she is awake and supervised. This will also help her develop shoulder strength.
  • Minimize the time spent in a car seat, which puts pressure on the same part of the head as back sleeping.

Iowa pediatrician Jack Swanson, MD, tells WebMD that the incidence of significant head flattening has increased sixfold since the back sleeping recommendations were issued, but there has also been a 40% to 50% decease in SIDS cases. Swanson serves on the AAP committee that issued the report, published in the July 1 issue of the journal Pediatrics.

"We definitely don't want to scare people away from placing babies on their backs while they are sleeping," Swanson says. "Head flattening is a cosmetic and largely reversible condition."

Plastic surgeon John Persing, MD, who also served on the committee, says flattened heads caused by sleep positioning can largely be prevented if new parents are told from day one to alternate their baby's head position from left to right each night. If a deformity does occur, it can usually be easily corrected if spotted in the first few months of life.

After that, a skull-molding helmet may be needed in cases where a severe deformity occurs or the skull is resistant to other therapeutic adjustments. Surgery may be needed in rare cases, but Persing says 99.9% of the time the deformity can be corrected without it.

"Many pediatricians think this is a problem that will improve with time, but it is important to identify it early," Persing tells WebMD. "Parents need to be made aware that virtually all of the flattening related to sleeping position can be avoided by alternating head positions on a nightly basis."

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