What in the world is plagiocephaly?

Also known as Flat Head Syndrome, plagiocephaly (sounds like “play-gee-oh-seff-uh-lee”) is basically the malformation of a baby’s skull.

It slowly develops when uneven pressure points on a newborn’s head shift the extremely malleable cranial bones into odd shapes. The effects can be severe, and cranial deformities have become much more common in the past 20 years. In fact, as you’ll soon read, nearly half of all babies have Flat Head Syndrome!

You might be wondering why that is...

In an effort to reduce the number of tragic SIDS deaths nationwide, the American Academy of Pediatrics started recommending that parents place babies on their backs to sleep. Formerly known as the “Back to Sleep” campaign, this “Safe to Sleep” movement began in 1994 and was backed by the US National Institute of Child Health and Human Development (NICHD), so parents everywhere began to take heed.1 [1 - *source: https://www.cdc.gov/sids/data.htm]

In conjunction with “Safe to Sleep,” “The ABC’s of Safe Sleep” also had a significantly positive impact. Its premise of “A for alone” calls for baby to sleep alone in a crib (no co-sleeping), and emphasizes the importance of removing all suffocation hazards such as toys, bedding, and loose objects. “B is for back,” and urges parents to place babies on their backs to sleep, not on their sides or stomachs. “C is for crib,” and encourages parents to use a crib with a firm mattress and tight-fitting sheet. (Speaking of mattresses, we’ll be discussing how to choose the safest one in a later report.)


“Safe to Sleep” and “The ABC’s of Safe Sleep” have both created massive impact and change since their beginnings, and SIDS deaths have plummeted by more than 50%. In the decade prior to these campaigns, more than 60,000 babies perished from SIDS - that’s more than 6,000 babies a year!2 [2 - *source: https://www.cdc.gov/mmwr/preview/mmwrhtml/00043987.htm] Thankfully these two concepts came around when they did, because they’ve saved thousands of babies’ (and—quite likely—parents’) lives. 

But there was a negative repercussion no one saw coming… Plagiocephaly.

As parents everywhere began to heed these life-saving guidelines, there was a surge in the number of babies who developed flat spots and misshapen heads. According to a study by the American Academy of Pediatrics (AAP) in 20133 [3 - *source: http://pediatrics.aappublications.org/content/early/2013/07/02/peds.2012-3438], an estimated 47% of all babies have some sort of flat spot on their heads as a result of being placed on their backs to sleep. It’s such an incredible statistic that it was even featured on CBS news!4 [4 - *source: http://www.cbsnews.com/news/study-flat-head-syndrome-found-in-47-percent-of-infants/]

Unfortunately, my firstborn was one of those statistics.

As new parents, my husband and I strictly adhered to the suggestions and recommendations of our pediatrician and the AAP, so we dutifully put our son on his back for sleeping, and made sure to remove all suffocation hazards. But, like a lot of back-sleeper babies, he ended up with a severely misshapen head.

After a visit to the pediatrician, we learned he would not only would he have to suffer through wearing a corrective helmet (and that’s after having to wait until he was 6 months old so his neck could support its weight), it would cost us a whopping $2,000. And—surprise, surprise—insurance refused to cover the cost, as they deemed plagiocephaly a “cosmetic” condition that didn’t inhibit brain function.

To make things worse, after he’d been wearing the unsightly helmet for several weeks, I noticed some sores against his soft skin, and it was starting to rub off a couple patches of his silky baby hair.

So I had a miserable, uncomfortable baby in a helmet we all hated and everyone questioned (I can’t even remember how many times we got the, “Oh, bless his heart” look, or the even more forward, “What’s wrong with him?” questions!). But if we didn’t use the helmet, we worried we’d have a child who might have to endure a flattened head (and possible bullies) for life.

The months he had to wear that contraption seemed like years, and we finally called it quits after finding a huge, oozing lesion that simply looked too painful to have anything touching it.

Refusing to allow our second child to suffer the same fate, so we started researching potential solutions.

“An ounce of prevention is worth a pound of cure.” - Benjamin Franklin

As previously mentioned, babies are born with very malleable skulls so they can endure the immense pressure of the narrow birth canal. But at around 6 months, the skull starts to harden and fuse as the soft spots and fibrous suture lines are replaced with calcified bone.

So a question remains on every parent’s mind - how can I prevent a flat or misshapen head while still abiding by the AAP’s insistence on back sleeping?

In attempts to provide solutions, several “head-shaping pillows” hit the market, ranging in price from $12-$120+. But, as you might imagine, you’ve got to be educated and do your research if you decide to go that route.

Remember how one of the “ABC’s of Safe Sleep” is “A for alone”? Well, whether your baby is better off alone (no pillow) or with a head-shaper depends on a few different factors:

  1. The pillow MUST be breathable. Period.

If—heaven forbid—you had to choose between plagiocephaly or SIDS/suffocation, the choice is pretty obvious. So if a head-shaping pillow has any chance of suffocating your baby, you’re both better off without one. Check the pillow’s Air Permeability Rating — the higher, the better.

  1. The shape is important.

You’ll want a pillow that’s had a lot of research and testing to back it up, because some pillows with poor engineering have spots or holes in the middle that can still leave a small flat spot. And don’t even get me started on all the little cutesy shapes that provide absolutely no effective support to even out pressure points and encourage a round head...

  1. The materials should be safe and non-toxic.

Whatever the pillow is made of and covered with is going to be smack dab against your baby’s biggest organ for over half of the first 6 months of life. So make sure it’s not something that will slowly leach chemicals or toxic junk into that tiny little body, and again, make sure it’s truly breathable!

  1. The quality and longevity matters.

Your baby will (ideally) be spending over half the day with this pillow, so if it breaks down, is made too flimsy or thin, or won’t bounce back after repeated use, it’s a total waste of money.

  1. The sizing is crucial to correct skull formation.

If you see a pillow that fits the bill so far, but offers only one size, keep looking. A baby’s head size and shape are significantly different at 1 month than at 6 months, so look for a pillow that offers a couple different sizes. That way you can be sure the pressure distribution and support is promoting proper cranial growth. See the chart below to get a sense of the average circumference size of baby’s head.




Some other things to consider once you find the perfect pillow:


  • The more, the merrier!

Your baby will likely be sleeping in more than one spot, so unless you want to cart the pillow around all over the place and risk losing it, you might want to grab one for each of baby’s sleeping spots. Make sure you’ve got upstairs and downstairs cribs, Pack ‘n Plays, and bassinets covered, and consider a designated daycare pillow. (And don’t forget grandma and grandpa’s house!)

  • Be the hero of the day (or, more accurately, lifetime)!
    Once you’ve found the ultimate plagiocephaly-preventer and it’s everything you dreamed, share the love! Be the person people love to see at baby showers (where a “cool and insanely useful gift” that impresses can be incredibly hard to find), share your priceless find with family and friends who are expecting, or those new parents who didn’t have the pleasure of your company (and #1 favorite gift) at their baby shower.

SIDS is becoming a thing of the past, thankfully, and we’d like to see plagiocephaly follow in its footsteps. Finding a safe, fully breathable head-shaping pillow that provides the perfect support is a great first step toward making that happen!

Keep an eye out for our next report, where we’ll dig into another aspect of the “A for alone” rule that no one can avoid using, whether you like it or not! (Spoiler alert - it’s the mattress!)

  • Nov 20, 2017
  • Category: Articles
  • Comments: 0
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