Are Parents Giving Babies Flat Heads?

BySusie L. Morris

July 7, 2003 -- Backs to sleep, tummies to play, will keep the flat-headed babies at bay.

That's how doctors might suggest parents prevent sudden infant death syndrome, or SIDS, while preserving the nicely rounded shape of their baby's head.

Apparently, according to a new report from the American Academy of Pediatricians, or AAP, there has been an observable, though slight, increase in incidence of minor skull deformity in infants in the past 11 years.

Explains Dr. Jack Swanson, task chairman of the committee on practice and ambulatory medicine and co-author of the report published today in the journal Pediatrics: "In 1992, the AAP recommended putting babies on their backs to sleep to prevent SIDS." As a result, SIDS cases have since decreased by 50 percent.

But, Swanson reports, more infants have experienced "head flattening" as a result of sleeping in the same position night after night.

A Mainly Cosmetic Concern

Head flattening is primarily a cosmetic concern, physicians agree. "Most babies have some mild degree of it [head malformation]," says Dr. Daniel R. Bronfin, vice chairman of the Department of Pediatrics and director of the craniofacial team at the Ochsner Clinic Foundation in New Orleans.

Previous studies report minor head malformation in one in every two babies, while severe problems only affect about one in every 300 infants, Swanson says. Bronfin adds that the problem is "fairly common, … but generally benign."

More severe cases affect about one in every 2000 babies, says Dr. Lindsey K. Grossman, professor at the division of general pediatrics at the University of Maryland, Baltimore.

The most serious case of skull deformity is a condition called craniosynostosis, which occurs when the infant's skull develops improperly, but is not linked to the baby's positioning. Severe cases warrant the use of corrective helmets and surgery.

"For the majority of babies with positional plagiocephaly [misshapen heads due to positioning], this intervention usually works, and the condition usually corrects itself," Bronfin says. If the head appears to retain an abnormal shape, doctors urge parents to consult their health-care providers.

Yet head deformity is a "minuscule problem compared to the issue of SIDS," he says.

"The concern about SIDS is far more serious than positional molding," stresses Dr. Kevin P. Sheahan, who regularly counsels new parents on how to safely coordinate a back-nap regimen coupled with some active belly time.

Supine for Sleep; Prone for Play

Since the AAP's inception of the "Back to Sleep" campaign, many parents have been "very careful to keep their babies on their backs," says Grossman.

In fact, many parents are fearful of any on-stomach positioning of their infants, says Sheahan, chief of pediatrics at Alfred I. DuPont Children's Hospital in Wilmington, Del.

But supervised "tummy time" also has its benefits, he adds. It encourages use of the arms and prompts strengthening and development of the arm muscles, as well as the head, says Grossman.

While keeping babies active and on their stomachs is encouraged while they're playing, so is alternating the baby's head position while they're sleeping. One technique is to move the crib or rearrange the nursery so the baby changes his or her vantage point while looking out from the crib.

The new data certainly should not discourage parents from abandoning the supine sleep setup, emphasizes Grossman. "Play with them, hold them, but put them on their backs to sleep."

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