Once the cause of a baby’s skull flattening has been removed i.e. through re-positioning, exercises, stretching, time or treatment, common questions asked by parents are “will the flat spot go away?” or “how much of it will resolve?” and “how long will it take?”.

There are no simple answers to these questions as each case is unique but I will cover some of the factors that may influence the outcome.

SEVERITY.  Most babies with an acquired flattening of their skull (deformational plagiocephaly) will improve over time.  The more severe the deformation, the less likely the flattening will be completely resolved.  Mild cases, where the cause of the flattening is addressed early on (i.e.within 1-2 months) are more likely to resolve completely.  Moderate and severe cases often improve with time but may be less likely to resolve completely.

There are a number of ways to grade the magnitude of a plagiocephaly case and monitor it’s progress over time. This is best done by a health professional with experience in this area.  Some of the things a parent can look for include: Does the forehead protrude forward on the affected side, and if so is it visible from front-on or only when viewed from above (deformation is typically less if only visible from above)? Looking from above the baby’s head, is the ear on the affected side pushed forward relative to the face? Looking at the baby’s head from side-on, has the affected side of the rear skull lost it’s rounded shape compared to the less affected side?

BABY’S AGE. The quicker a parent can identify and address the cause behind the skull flattening the better. It is common for parents to first notice deformational plagiocephaly around 2 months of age but it is likely in many cases that the flattening process started weeks before then.  A baby’s skull is heavy and cranial bones are most malleable in the early months of life (this is one of the reasons the problem tends to occur in the first place).  As a result, the best window for short term head shape recovery is in the first 6-12 months of life.

An average baby’s head circumference will grow by 11cm (31%) in their first year (much of this occurs in the first 7 months).  This rapid growth in brain and skull size is likely to assist with rounding out the head shape.  By comparison, in the second year of life their head will gain on average only 2.25cms (5%).  After that the head will typically add only 0.5cm per year till maturity.

FONTANELLE SIZE. The size of the Anterior Fontanelle (soft part on the top/front of the skull) can give some indication of skull/suture malleability.  A baby with a large Anterior Fontanelle may have greater scope for head shape recovery in the first 12 months of life compared with a similar baby with a small Anterior Fontanelle.

BONY CHANGE OVER TIME. As the child’s skull grows and matures with age, there is still scope for improvement in head shape by changes in bone structure and shape.  The rate of change here is slower but the bones of the skull will change shape and size a great deal in the years that follow. Think of how much their face, nose, jaw and eye sockets will change as they reach school age, high school age and adulthood.

I hope you find this article helpful. If you have any questions on this topic please do not hesitate to contact our office on 8272 2862 or by email.

Sincerely, Richard