The flat back of the head: prevention, causes and treatment

Last year in October, I attended the 5th Bremen Symposium on the Promotion of Breastfeeding. There I was able to listen to various lectures that not only addressed breastfeeding itself. I was also able to listen to the author and pediatrician Herbert Renz-Polster talk about the "flat" back of the head. I would like to summarize a few important points and my thoughts on them in this article.

Since the topic of the flattened back of the head (and front of the head) comes up again and again in various reference books and I also dealt with it during my training as an occupational therapist, I am no stranger to the phenomenon.

Studies have shown that positional plagiocephaly, as the flattened back of the head is medically called, has only been occurring for some time and only in certain cultures. In a 2004 study, the percentage of 6-week-old babies with a flattened occiput was 16%. I suspect that it has actually increased significantly in the meantime. There are no records of such a skull change from earlier times, it is only in the early 1990s that this is increasingly described. Here, bearing-related means that the deformation is acquired after dedr birth and was caused by the bearing. But I will go into this in more detail.

The beautifully pronounced back of the head is part of the child schema, as are the large eyes, the overall large head and the high forehead, to name just a few examples. The Kindchenschema ensures, with the support of various hormonal processes, that we find babies cute and take care of them. Because that's what they depend on. So if the round back of the head is missing, part of this schema is also lost.

Prevention, causes and treatment

The causes are not always clear-cut. Almost always it is the sum of various factors. How I can prevent the flat back of the head and what I can do if my baby already has it are the same. In rare, serious cases, further measures are necessary, which must then be discussed with the pediatrician.

In our culture, the supine position is recommended for sleeping because it has been proven to reduce the risk of Sudden Infant Death Syndrome(SIDS). But is the supine position itself to blame for the flat back of the head? No. Babies in many other cultures also sleep exclusively on their backs and no flat back of the head has been observed there.

So what is it then, if not the supine position? In the lecture, Herbert Renz-Polster explains that it is the duration of the supine position and the lack of movement.

Baby car seats and strollers play a role here. Especially in car seats, babies are not given much movement for their heads. For driving in the car, of course, this is good and safe, but for a longer duration even at home and during walks, they are simply not suitable. Children also tend to lie on their backs in strollers. However, since I am watching my child here, I can also lay my baby sideways, although the positioning is not quite as easy in this case.

The easiest way to avoid this kind of pressure on the head is to carry in a sling or a baby carrier. Here there is no pressure on the back of the head and generally babies also turn their heads regularly.

Another point is the type of feeding or feeding. Breastfeeding while the baby is completely on its back is hardly possible. This also prevents continuous pressure on the back of the head. This should not really be the case with bottle feeding either. It is basically not optimal to feed your baby in the supine position. It is better to change sides and have a lot of body contact, as is the case with breastfeeding.

In addition, baby sleep also plays a role in relation to the back of the head, of course. Babies should sleep in the supine position, according to current recommendations. So if they are constantly in the supine position during the day and at night, the pressure influence on the skull is always the same and increases the risk of flattening, because newborns are known to sleep a lot. But how do I make sure that the head does not become "flat"? One possibility is breastfeeding at night. The baby can't lie on its back at all, it must at least turn its head to the side.

When mothers sleep with their babies, there is another phenomenon. In sleep laboratories, with the help of infrared cameras, it has been found that breastfeeding mothers regularly "reposition" their babies even when they are asleep, soothing them and nursing them even when they are half asleep. As a result, a baby is never in the same position for long. Movement while sleeping is just fine in terms of skull shape. By the way, swaddling significantly restricts movement, but I don't want to go into that in this context.

However, co-sleeping or family bed is a decision that does not suit every family and not everyone is comfortable with it. Therefore, even with the other areas, it is always an individual path that should fit the family and the current situation.

So, in summary, I can say that carrying, breastfeeding and sleeping together are well suited as therapy for a flattened occiput. They are also optimal for prevention, so that a deformity does not develop in the first place.

The cover image comes from unsplash.com.