What is Flat head syndrome?

Flat head syndrome, also known as positional plagiocephaly, is a condition where a baby’s head flattens due to repeated pressure on one part of the skull. This occurs due to the soft and flexible nature of the baby’s skull during the early months of life, allowing it to be easily shaped by external pressure. Manifestations of the condition are observed on the posterior or lateral aspects of the cranium.

Causes 

• Babies who sleep on their backs for extended periods, which is recommended for SIDS prevention, may develop a flat spot if they consistently rest on the same side.
• The lack of time spent on the tummy during awake hours increases the risk of flattening due to more time lying on the back.
• Torticollis is a condition where a baby’s neck muscles are tight or imbalanced, causing the head to tilt or turn more frequently.
• Car seats, swings, or carriers can cause flat spots due to continuous head contact with hard surfaces over prolonged periods of use.
• The soft skulls of premature babies, combined with extended time spent lying in the NICU, raise their susceptibility to head shape abnormalities (like plagiocephaly).
• When there are multiple babies, such as twins, sharing the limited space within the womb, it can result in pressure on their heads, leading to head flattening.

Symptoms 

A baby’s head might look flat, often showing asymmetry in the head, misaligned ears, or even slight facial asymmetry. This condition typically doesn’t cause pain, developmental issues, or neurological symptoms but may cause a noticeable head or forehead asymmetry.

What is Craniosynostosis?

Craniosynostosis is a condition where a baby’s skull’s bones fuse prematurely before the brain has fully developed. The skull, consisting of multiple bones connected by sutures, expands during infancy. If a suture closes too soon, it can alter the head’s shape and potentially cause pressure on the growing brain.

Causes 

Craniosynostosis, a rare genetic disorder, is often linked to family history, certain genetic conditions, and male gender, with males being more common. Risk factors include genetic changes.

Symptoms 

Parents may notice unusual head shapes, raised ridges along the suture line, asymmetric facial features, bulging soft spots, slow head growth, and, in rare cases, increased head pressure symptoms like vomiting, sleepiness, or irritability. Not all abnormal head shapes are caused by craniosynostosis; some are due to sleep position pressure, such as flat head syndrome, which is less serious.

Flat head syndrome vs Craniosynostosis

Infants’ cranial growth, facilitated by the skull’s flexible bones, can disrupt or alter in some cases, leading to abnormal head shapes. Two common conditions are Flat Head Syndrome (positional plagiocephaly) and Craniosynostosis, but their causes, implications, and treatments differ significantly. Both conditions can cause head shape abnormalities.

Causes and Pathophysiology

Flat Head Syndrome is a condition caused by prolonged external pressure on an infant’s head, often resulting from prolonged lying on their backs. Factors contributing to this condition include limited tummy time, torticollis, and the infant’s preference for turning their head to one side. Craniosynostosis is a congenital condition caused by premature fusion of cranial sutures, which are supposed to remain open during infancy for brain growth. When these sutures close too early, abnormal skull growth and increased intracranial pressure can occur. The severity and shape of skull deformity depend on the affected suture.

Clinical presentation

Flat Head Syndrome is a condition where children have an asymmetrical or flattened area on their head without any facial or fontanelle changes. It is not linked to neurological issues. Craniosynostosis, on the other hand, can result from sagittal or coronal suture fusion, causing a flattened forehead on one side. It may also cause facial asymmetry, fontanelle bulging, or developmental delays, especially if intracranial pressure increases.

Empowering parents: Key differences every parent should know

Parents often worry about their baby’s head shape, especially in the early months. Flat Head Syndrome and Craniosynostosis are two possible conditions that may arise in discussions with a paediatrician. Both affect a baby’s skull shape, but they differ in cause, severity, and treatment. Both conditions can cause a flat spot on the head, which is normal and can be addressed by a paediatrician.

• Flat Head Syndrome (Positional Plagiocephaly) occurs when a baby spends a lot of time lying in one position, often on their back, causing pressure in one area. This condition is often related to sleeping habits or limited tummy time. Craniosynostosis is a medical condition where one or more soft joints in a baby’s skull close too early, causing the head to grow abnormally and increasing pressure inside the skull.
• Flat Head Syndrome is a cosmetic condition that affects the head shape but not the brain, affecting most babies. Craniosynostosis is more serious and can cause problems with brain growth, vision, or development if left untreated.
• Flat Head Syndrome causes a flat spot on the back or side of the head, with slightly misaligned ears. Craniosynostosis causes abnormal head shapes, such as a bulging forehead or long, narrow, or uneven head, with facial asymmetry being more common.
• Flat Head Syndrome can be diagnosed through a physical exam, with imaging rarely needed. At the same time, Craniosynostosis often requires CT scans or X-rays to confirm early skull suture closure and plan treatment.
• Flat Head Syndrome can be managed at home with tummy time, sleeping positions, and helmets. Craniosynostosis requires surgery to open fused sutures and allow proper skull growth, with better outcomes when caught early.
• If your baby’s flat spot persists after repositioning or if you observe unusual head shape, bulging at the soft spot, or slow head growth, it’s crucial to consult a paediatrician or craniofacial specialist.

Flat head syndrome and Craniosynostosis are conditions that affect the head’s shape, but they have distinct causes and treatment methods. Parents should consult a healthcare professional if they have concerns about their child’s head shape or development, as understanding these differences can help them make informed decisions about their child’s care. Both conditions have distinct causes and treatment approaches, making it crucial for parents to consult a healthcare professional for proper evaluation and guidance.

About Dr Vishakha : 

Dr Vishakha Basavraj Karpe is a highly skilled senior consultant at Rainbow Children’s Hospital in Banjara Hills and Hydernagar Hyderabad. She is known for her comprehensive care approach and is one of the few dedicated leading paediatric neurosurgeons in the city and India with over ten years of extensive experience in pediatric neurosurgery. Her expertise includes treating hydrocephalus, spinal dysraphism, craniosynostosis, paediatric brain infections, brain and spine tumours and stroke surgery. 

She has a special interest in craniosynostosis surgery, which is done only in very few centres in India.

Proficiency of Dr Vishakha:

1. 1. Hydrocephalus (increased fluid in the brain): The procedure involves an endoscopic third ventriculostomy and CSF diversion (VP shunt) to treat complex hydrocephalus.
   2. Craniosynostosis (abnormal head shape due to untimely cranial sutures fusion) surgeries: Helmet therapy is a technique that is used in both endoscopic and open surgery.

• Spinal dysraphisms(Spina Bifida)- (spinal abnormalities present by birth) – surgical repair

• Encepahaocles repair surgery.

1. 1. Vascular conditions and stroke surgeries: revascularization surgeries for moya moya disease.

• Pediatric brain and spine tumour surgeries.

1. 1. Pediatric brain and spine infection surgeries: Endoscopic and open surgeries for brain and spine infections.

• Pediatric traumatic brain and spinal injury.

• Antenatal counselling for congenital fatal neurosurgical conditions.