Sleeping position: Can it cause a misshapen head?

I have heard that more babies have a problem with a distortion in the shape of their head, caused in part by the recent trend of positioning infants on their backs to sleep. Can this be dangerous to babies?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

You pose an interesting and very timely question. The question about whether infant positioning is causing some misshaping of infant heads has had a flurry of attention both in the pediatric literature and in the newspapers.

It has been a while since the American Academy of Pediatrics made the recommendation that all infants be placed to sleep on their backs or sides. Citing studies done in other countries, the AAP felt that placing infants to sleep in this position would significantly decrease the incidence of Sudden Infant Death Syndrome. Since this recommendation many physicians have seen an increase in infants with the backs of their heads somewhat flattened or misshapen. So, the answer to your question is a definitive, yes. At the time of this writing however, there has been no research to support the idea that there has been increase in infants with misshapen heads caused by putting infants to sleep on their backs.

The question of misshapen heads goes farther than just cosmetic problems. The skull is made up of many different bones which grow as the child grows until they eventually completely fuse in adulthood. The "soft spot" you feel on baby's head is where the bones meet, but have not yet fused. However, in some children, these bones fuse early (called craniosynostosis) which can cause a misshaping of the head as well as increased pressure on the brain. The dilemma physicians and parents are faced with is figuring out what is causing the skull abnormality. If it is positional, only cosmetic problems will occur. If it is craniosynostosis, surgery may be required to correct the defect. Almost always, positional misshaping can be determined with a careful physical examination and confirmed if necessary with x-rays.

I currently recommend that children under the age of nine months, whose parents feel the head shape is detrimental, undergo intervention in one of two ways. For mild abnormalities, different positioning may be feasible. However, for the more involved misshaping, I suggest the child be fitted with a helmet, which is custom made and to be worn no less than 23 hours a day for at least three months. This is quite a commitment, both in terms of time and money (cost is about $2000).

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