Caitlin Whyte (Host): Welcome to BayCare HealthChat. I'm your host, Caitlin Whyte. And in this episode, we are going to go over flat head syndrome and how to prevent it. Joining us for this conversation is Dr. Pat Ricalde. She is an oral and maxillofacial surgeon. Well, to start us off today, doctor, can you tell us what is flat head syndrome?

Dr. Pat Ricalde: Flat head syndrome is actually a condition known as plagiocephaly, meaning that when babies are born, their heads are very malleable. The baby's skull is made up of multiple bones that are separated by soft tissue junctures called sutures. And those sutures are made of soft tissue so that the head can distort and get through that birth canal without causing injury to mom or to baby's brain. So often when babies are born, they have flat spots on their head that hopefully will round out those first couple months of life. Sometimes, those flat spots don't round out and that's when you get flat head syndrome or plagiocephaly.

Host: So when something like this does occur, are we only seeing it in newborns, right when they're born, or are we seeing this at other ages develop?

Dr. Pat Ricalde: Well, I think it's very common to see it in a newborn. People expect newborns to have misshapen heads, certainly. But it can occur after the first month or two months of life as well, because oftentimes they have a favorite sleep position or maybe they were positioned in such a way in mommy's belly that their neck was kinked or rotated. And so, their neck muscles are asymmetric, and that keeps them laying onto a certain spot that might perpetuate or accentuate a flat spot that becomes more and more apparent over the first couple months of life. So yeah, it can manifest within the first few months.

Host: All right. And you just mentioned a few things that can cause this flat head syndrome, like the process of being born and favoring a sleeping angle, but are there any other causes?

Dr. Pat Ricalde: Well, when we're talking about plagiocephaly or flat head syndrome, we're talking about deformational molding. There are other things that can mimic deformational molding. Deformational molding is essentially because of extrinsic pressure on the head that is causing it to flatten out, whether it's because of the position in utero or inside mommy's belly or whether it's the sleep position, or maybe because of an asymmetric neck muscle. Those are the most common causes of deformational molding, but we do want to differentiate that from a flat head that's not due to deformational molding because there are other things, a tumor, for example, or craniosynostosis, which are more serious conditions that require a full medical workup.

Host: Well, talking about flat head syndrome, once again, who is at risk for that?

Dr. Pat Ricalde: So, babies who are carried around in car seats are probably a little bit more at risk, or babies who are carried in carriers that don't allow neck range of motion to occur are going to be at higher risk. So, it is helpful for babies to have tummy time, even right from the beginning, allow them to rotate their neck, maybe even do some gentle neck exercise so that they get that flexibility to occur early on rather than keeping them cocooned too much and not allowing them that neck rotational movement to move the head and allow for the natural rounding to occur.

Other infants that may be at increased risk for having flat head syndrome are kids who have surgeries early or who have medical needs that maybe keep them in the hospital longer than just the one day, they may also be at increased risk for having flat spots occur.

Host: Well, with all of these groups that are at risk, are there any medical conditions or complications that come with flat head syndrome?

Dr. Pat Ricalde: So, there's a lot of talk. There has been lots of research to try to see if flat head syndrome can cause medical issues, but really nothing has been supported. So, for example, some people worry that maybe it will increase your risk of ear infections, or it will increase your risk of developmental delays, and that just has not been found. So, it may be the other way around. If a kid has developmental delay, and they're not rolling, for example, in a timely fashion, that might increase your risk of having the flat spot, but the flat spot's not going to cause any brain problems or medical conditions to occur.

Host: Well, that is always good to hear. Thank you so much. Now, if I'm noticing a flat spot on my baby, when should I consult the doctor?

Dr. Pat Ricalde: There's a lot you can actually do on your own before seeking medical care, because again, it's so common for newborns to have flat spots and to have favorite sleep positions. So, I would start simply by giving baby lots of tummy time and you can start tummy time by putting baby just on your chest and leaning back and getting them used to chest to chest or skin to skin contact, letting that baby's neck rotate left to right and encouraging the baby to turn the head in different directions.

You want your child to be able to flex and extend that head. You can start some gentle neck exercises, which you can do just by simply massaging the neck and the back with careful massage techniques to just allow flexibility to occur. And sometimes, it's just as simple as that.

The other thing you can do is when you're positioning baby to sleep, of course, you always put your baby on their back to sleep with nothing in the crib or bed to decrease any risk of SIDS. But you want to make sure that the baby has an opportunity to look left and right. So if there's an interesting object to the right of the room, like a light or a mobile or a sound machine, they're going to tend to look towards that side. So, maybe rotate the baby 180 degrees so that the next night they're looking to the left, and then the following night they're looking to the right so that they do get that movement at night.

Host: And it sounds like you said there's a lot that we can do at home, just parents with their babies at nighttime. So, is this something that could correct itself without maybe medical intervention?

Dr. Pat Ricalde: Yes. Usually, it does correct itself, and that's the goal is to try to give your baby an opportunity. The body's an amazing healer, right? You give the body an opportunity, and it does oftentimes correct itself. But sometimes it doesn't. Sometimes it will get worse with time. And usually, by about four months of age, it's pretty obvious if things are going to get better or not. And if you're not seeing the trajectory in a positive direction, then it might be time to ask your pediatrician for an evaluation or consider a referral.

Host: Gotcha. Well, that is my last question here today. Maybe we hit that four-month period like you said, and we're still not seeing improvements, what are some treatments for flat head syndrome then?

Dr. Pat Ricalde: Well, like I said, exercises, you can do formal exercises targeted to the muscle groups that are tight, so physical therapy, but also you can consider helmet therapy. A helmet can be custom fabricated to the baby's head where it has contact in any areas that are bulgy and then there's relief or space in the helmet where the baby has a flat spot so that the baby will preferentially grow out that flattened area. The helmet has to be worn 23 hours a day, which is a bit of a drag, but it's very effective in correcting flat spots.

Host: Well, just a very interesting episode. Thank you so much for joining us today, Dr. Ricalde. And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media and be sure to check out all of the other interesting podcasts in our library. I'm Caitlin Whyte.